Healthcare Provider Details

I. General information

NPI: 1881059525
Provider Name (Legal Business Name): MFI RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17270 ROOSEVELT STREET
RIVERSIDE CA
92508-9523
US

IV. Provider business mailing address

5870 ARLINGTON AVENUE
RIVERSIDE CA
92504-2037
US

V. Phone/Fax

Practice location:
  • Phone: 951-683-6596
  • Fax: 951-683-4239
Mailing address:
  • Phone: 951-683-6596
  • Fax: 991-351-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number330013AN
License Number StateCA

VIII. Authorized Official

Name: MRS. JOSSYE KARIN COOK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 951-683-6596