Healthcare Provider Details

I. General information

NPI: 1932523610
Provider Name (Legal Business Name): RIVERSIDE RECOVERY RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40329 STETSON AVE
HEMET CA
92544-7358
US

IV. Provider business mailing address

PO BOX 549
LAKE ELSINORE CA
92531-0549
US

V. Phone/Fax

Practice location:
  • Phone: 951-658-4466
  • Fax: 951-294-5806
Mailing address:
  • Phone: 951-290-5870
  • Fax: 951-294-5806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number330009FN
License Number StateCA

VIII. Authorized Official

Name: BERNARD L TRUAX II
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 951-290-5870