Healthcare Provider Details

I. General information

NPI: 1477665651
Provider Name (Legal Business Name): RIVERSIDE CO. LATINO COMMISSION ON ALCOHOL AND DRUG ABUSE SVCS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46883 MONROE ST
INDIO CA
92201-6768
US

IV. Provider business mailing address

1612 1ST ST
COACHELLA CA
92236-1407
US

V. Phone/Fax

Practice location:
  • Phone: 760-398-9000
  • Fax: 760-398-9790
Mailing address:
  • Phone: 760-398-9000
  • Fax: 760-398-9790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number330037AN
License Number StateCA

VIII. Authorized Official

Name: MR. LEONEL CONTRERAS SR.
Title or Position: EXECUTIVE DIRECTOR
Credential: CAS
Phone: 760-398-9000