Healthcare Provider Details

I. General information

NPI: 1336760644
Provider Name (Legal Business Name): RIVER STONES RESIDENTIAL TREATMENT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 CORONADO DR
REDLANDS CA
92374-6293
US

IV. Provider business mailing address

PO BOX 7340
REDLANDS CA
92375-0340
US

V. Phone/Fax

Practice location:
  • Phone: 909-748-7141
  • Fax: 833-272-3431
Mailing address:
  • Phone: 909-748-7141
  • Fax: 833-272-3431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LOLA MULLINGS
Title or Position: OFFICE MANAGER
Credential:
Phone: 909-748-7141