Healthcare Provider Details

I. General information

NPI: 1184997520
Provider Name (Legal Business Name): RIVERSIDE COUNTY LATINO COMMISSION ON ALCOHOL AND DRUG ABUSE SERVICES,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86150 AVE. 66
THERMAL CA
92274
US

IV. Provider business mailing address

83844 HOPI AVE
INDIO CA
92203-2638
US

V. Phone/Fax

Practice location:
  • Phone: 760-398-9000
  • Fax: 760-397-9790
Mailing address:
  • Phone: 760-347-9442
  • Fax: 760-342-8022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number01970566
License Number StateCA

VIII. Authorized Official

Name: MR. LEONEL CONTRERAS
Title or Position: EXECUTIVE DIRECTOR
Credential: CAS II
Phone: 760-347-9442