Healthcare Provider Details

I. General information

NPI: 1164194080
Provider Name (Legal Business Name): MFI RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43250 MIDNIGHT CT
BANNING CA
92220-9565
US

IV. Provider business mailing address

5870 ARLINGTON AVENUE
RIVERSIDE CA
92504-2037
US

V. Phone/Fax

Practice location:
  • Phone: 951-683-6596
  • Fax: 951-683-4239
Mailing address:
  • Phone: 951-683-6596
  • Fax: 991-351-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOSSYE KARIN COOK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 951-683-6596