Healthcare Provider Details

I. General information

NPI: 1598899106
Provider Name (Legal Business Name): JOHN A CAHILL SUDCC II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 RUSTIN AVE # 5
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

2085 RUSTIN AVE # 5
RIVERSIDE CA
92507-2498
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-2400
  • Fax:
Mailing address:
  • Phone: 951-966-2170
  • Fax: 951-294-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number01-034424
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: