Healthcare Provider Details

I. General information

NPI: 1013200831
Provider Name (Legal Business Name): RIVER CITY RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12490 ALTA MESA RD
HERALD CA
95638-8409
US

IV. Provider business mailing address

500 22ND ST
SACRAMENTO CA
95816-3503
US

V. Phone/Fax

Practice location:
  • Phone: 209-748-2470
  • Fax:
Mailing address:
  • Phone: 916-442-3979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number340002AN
License Number StateCA

VIII. Authorized Official

Name: CRAIG KOURY
Title or Position: EXECUTIVE DIRECTOR
Credential: CAS II, NCAC
Phone: 916-442-3979