Healthcare Provider Details

I. General information

NPI: 1922344373
Provider Name (Legal Business Name): RIVERSIDE RECOVERY RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10551 BELLEGRAVE AVE JURUPA VALLEY HIGH SCHOOL
MIRA LOMA CA
91752-1800
US

IV. Provider business mailing address

PO BOX 549
LAKE ELSINORE CA
92531-0549
US

V. Phone/Fax

Practice location:
  • Phone: 951-294-5882
  • Fax: 951-294-5806
Mailing address:
  • Phone: 951-294-5882
  • Fax: 951-294-5806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CINDY SIMPSON
Title or Position: CLINIC DIRECTOR
Credential: MSW, RAS, PHD
Phone: 951-294-5882