Healthcare Provider Details

I. General information

NPI: 1023865326
Provider Name (Legal Business Name): KINDFUL RESTORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7344 MAGNOLIA AVE STE 110
RIVERSIDE CA
92504-3819
US

IV. Provider business mailing address

7344 MAGNOLIA AVE STE 110
RIVERSIDE CA
92504-3819
US

V. Phone/Fax

Practice location:
  • Phone: 951-404-0856
  • Fax: 951-755-8856
Mailing address:
  • Phone: 805-622-7747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: ERNEST B RODRIGUEZ BELLO
Title or Position: CO-EXECUTIVE DIRECTOR
Credential: SUD/CHW
Phone: 951-934-8183