Healthcare Provider Details

I. General information

NPI: 1568890622
Provider Name (Legal Business Name): RIVERSIDE COUNTY LATINO COMMISSION ON ALCOHOL AND DRUG SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2013
Last Update Date: 02/27/2021
Certification Date: 02/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83385 ROSA AVE
THERMAL CA
92274-9506
US

IV. Provider business mailing address

1612 1ST ST
COACHELLA CA
92236-1407
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LEONEL CONTRERAS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 760-347-9442