=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962310284
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVERCREST PARKWAY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2026
-----------------------------------------------------
Last Update Date | 08/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 682 RIVERCREST PKWY
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96002-3543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 279-258-5154
-----------------------------------------------------
Fax | 866-892-3394
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 682 RIVERCREST PKWY
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96002-3543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 279-258-5154
-----------------------------------------------------
Fax | 866-892-3394
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ROSS MORTON
-----------------------------------------------------
Credential | J.D
-----------------------------------------------------
Telephone | 916-741-5312
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------