MEDICARE: RIVERSIDE SEASON GROVE CLHF INC.

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
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1851220461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE SEASON GROVE CLHF INC.

Provider Business Mailing Address
First Line	:	19700 SEASON GROVE DR
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-1565
Country	:	US
Telephone Number	:	805-404-3934
Fax Number	:

Provider Business Practice Location Address
First Line	:	19700 SEASON GROVE DR
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-1565
Country	:	US
Telephone Number	:	805-404-3934
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EVA FE SOSNOVSKY
Credential	:
Telephone Number	:	805-404-3934

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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