Provider Demographics
NPI:1073663605
Name:NEIGHBORHOOD MEDICAL CLINIC OF RIVERSIDE
Entity Type:Organization
Organization Name:NEIGHBORHOOD MEDICAL CLINIC OF RIVERSIDE
Other - Org Name:DOGON PSYCHIATRIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-341-8935
Mailing Address - Street 1:231 E ALESSANDRO BLVD
Mailing Address - Street 2:A805
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-5084
Mailing Address - Country:US
Mailing Address - Phone:951-341-8935
Mailing Address - Fax:951-341-8932
Practice Address - Street 1:4960 ARLINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2738
Practice Address - Country:US
Practice Address - Phone:951-341-8930
Practice Address - Fax:951-341-8932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty