Healthcare Provider Details

I. General information

NPI: 1518097104
Provider Name (Legal Business Name): STACY S ADAMS SR. BS IN HUMAN SERVICES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3576 ARLINGTON AVE STE 100
RIVERSIDE CA
92506-3907
US

IV. Provider business mailing address

3576 ARLINGTON AVE STE 100
RIVERSIDE CA
92506-3907
US

V. Phone/Fax

Practice location:
  • Phone: 951-374-1555
  • Fax: 951-394-7426
Mailing address:
  • Phone: 951-374-1555
  • Fax: 951-394-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: