Organization Name: | RIVERSIDE RECOVERY RESOURCES |
NPI Number: | 1023343167 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | R KEITH SIMPSON (MEDICAL DIRECTOR) |
Mailing Address: | 2055 N Perris Blvd Ste G Perris |
State: | CA US |
Postal Code: | 925712509 |
Phone Number: | 9519406061 |
Fax Number: | 9516745227 |
NPI Enumeration Date: | 10/07/2009 |
NPI Last Update Date: | 08/02/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0405X |
License Number: | 330009PN |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
Taxonomy Definition: |