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
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1922344373
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	:	951-294-5882
Fax Number	:	951-294-5806

Provider Business Practice Location Address
First Line	:	10551 BELLEGRAVE AVE
Second Line	:	JURUPA VALLEY HIGH SCHOOL
City	:	MIRA LOMA
State	:	CA
Zip	:	91752-1800
Country	:	US
Telephone Number	:	951-294-5882
Fax Number	:	951-294-5806

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. CINDY SIMPSON
Credential	:	MSW, RAS, PHD
Telephone Number	:	951-294-5882

Provider Enumeration Date	:	12/12/2012
Last Update Date	:	12/12/2012

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Directions to “RIVERSIDE RECOVERY RESOURCES ” Practice Location

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