Provider Demographics
NPI:1013200831
Name:RIVER CITY RECOVERY CENTER
Entity Type:Organization
Organization Name:RIVER CITY RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:KOURY
Authorized Official - Suffix:
Authorized Official - Credentials:CAS II, NCAC
Authorized Official - Phone:916-442-3979
Mailing Address - Street 1:500 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3503
Mailing Address - Country:US
Mailing Address - Phone:916-442-3979
Mailing Address - Fax:
Practice Address - Street 1:12490 ALTA MESA RD
Practice Address - Street 2:
Practice Address - City:HERALD
Practice Address - State:CA
Practice Address - Zip Code:95638-8409
Practice Address - Country:US
Practice Address - Phone:209-748-2470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340002AN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA251S00000XOtherCOMMUNITY/BEHAVIORAL HEALTH