Healthcare Provider Details

I. General information

NPI: 1083902829
Provider Name (Legal Business Name): RIVERSIDE RECOVERY RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 E. ELLIS AVE PERRIS LAKE CONTINUATION HS
PERRIS CA
92571
US

IV. Provider business mailing address

PO BOX 549
LAKE ELSINORE CA
92531-0549
US

V. Phone/Fax

Practice location:
  • Phone: 951-940-6061
  • Fax: 951-674-5227
Mailing address:
  • Phone: 951-674-5354
  • Fax: 951-674-5227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LOIS ANN EASTERLING
Title or Position: CONTRACT ADMINISTRATOR
Credential:
Phone: 951-674-5354