Healthcare Provider Details

I. General information

NPI: 1750765475
Provider Name (Legal Business Name): ROBERT PRESLEY DETENTION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ORANGE ST
RIVERSIDE CA
92501-3613
US

IV. Provider business mailing address

4000 ORANGE ST
RIVERSIDE CA
92501-3613
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-4545
  • Fax:
Mailing address:
  • Phone: 951-955-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number27401
License Number StateCA

VIII. Authorized Official

Name: MS. KIM D. STRONG
Title or Position: CLINICAL THERAPIST I
Credential:
Phone: 951-955-4545