Healthcare Provider Details

I. General information

NPI: 1760522866
Provider Name (Legal Business Name): ROBERT PRESLEY DETENTION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 LEMON ST
RIVERSIDE CA
92501-3844
US

IV. Provider business mailing address

4275 LEMON ST
RIVERSIDE CA
92501-3844
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-8541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number203357
License Number StateCA

VIII. Authorized Official

Name: EDUARDO PEREZ
Title or Position: SUPERVISOR
Credential:
Phone: 951-955-8541