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NPI Code Detail

MEDICARE: RIVERSIDE RECOVERY RESOURCES

MEDICARE: RIVERSIDE RECOVERY RESOURCES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center330009QNCA

General Provider Information

NPI Number : 1730414707
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVERSIDE RECOVERY RESOURCES
Provider Business Mailing Address
First Line : PO BOX 549
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92531-0549
Country : US
Telephone Number : 951-674-7354
Fax Number : 951-674-5227
Provider Business Practice Location Address
First Line : 3757 ELIZABETH ST
Second Line :
City : RIVERSIDE
State : CA
Zip : 92506-2508
Country : US
Telephone Number : 951-674-7354
Fax Number : 951-674-5227
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DERRICK BRUCE HARVEY
Credential : CAS II
Telephone Number : 951-674-7354
Provider Enumeration Date : 10/08/2009
Last Update Date : 10/08/2009

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Directions to “RIVERSIDE RECOVERY RESOURCES ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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