Healthcare Provider Details

I. General information

NPI: 1902287741
Provider Name (Legal Business Name): BETTER DECISIONS COUNSELING RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 BROCKTON AVE
RIVERSIDE CA
92501-3201
US

IV. Provider business mailing address

3865 BROCKTON AVE
RIVERSIDE CA
92501-3201
US

V. Phone/Fax

Practice location:
  • Phone: 909-731-8667
  • Fax:
Mailing address:
  • Phone: 909-731-8667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MARQUECHO
Title or Position: EXECUTIVE DIRECTOR
Credential: RADT I
Phone: 909-731-8667