Healthcare Provider Details

I. General information

NPI: 1013110949
Provider Name (Legal Business Name): RIVER OAK CENTER FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 EL CAMINO AVE
CARMICHAEL CA
95608-4650
US

IV. Provider business mailing address

7484 HOLWORTHY WAY APT 115
SACRAMENTO CA
95842-4133
US

V. Phone/Fax

Practice location:
  • Phone: 916-609-5122
  • Fax: 916-609-5161
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAUNA BIRD
Title or Position: PROGRAM SERVICES CLINICIAN
Credential:
Phone: 916-284-3467