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General NPI Number Information
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NPI Number | 1437273521
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Entity Type | Organization
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Legal Business Name | THE CAROLYN E. WYLIE CENTER
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 4164 BROCKTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92501-3400
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Country | US
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Telephone | 951-683-5193
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Fax | 951-683-6019
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Provider Business Mailing Address
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Address Line | 4164 BROCKTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92501-3400
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Country | US
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Telephone | 951-683-5193
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Fax | 951-683-6019
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Authorized Official
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Title or Position | C.E.O.
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Name | MR. MICKEY RUBINSON
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Credential |
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Telephone | 951-683-5193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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