1821385410 NPI number — RIVERSIDE RECOVERY RESOURCES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821385410 NPI number — RIVERSIDE RECOVERY RESOURCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERSIDE RECOVERY RESOURCES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821385410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE ELSINORE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92531-0549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-674-5354
Provider Business Mailing Address Fax Number:
951-674-5227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31375 BRADLEY RD
Provider Second Line Business Practice Location Address:
PLOMA VALLEY HS
Provider Business Practice Location Address City Name:
MENIFEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92584-9368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-674-5354
Provider Business Practice Location Address Fax Number:
951-674-5227
Provider Enumeration Date:
07/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
EASTERLING
Authorized Official First Name:
LOIS
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CONTRACT ADMINISTRATOR
Authorized Official Telephone Number:
951-674-5354

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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