Provider Demographics
NPI:1073739413
Name:RIVER OAK CENTER FOR CHILDREN
Entity Type:Organization
Organization Name:RIVER OAK CENTER FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SKILLS TRAINER
Authorized Official - Prefix:MS
Authorized Official - First Name:THEODRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAREAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-609-4967
Mailing Address - Street 1:5030 EL CAMINO AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4650
Mailing Address - Country:US
Mailing Address - Phone:916-609-4900
Mailing Address - Fax:916-609-5160
Practice Address - Street 1:5120 FITZWILLIAM WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820
Practice Address - Country:US
Practice Address - Phone:916-609-4900
Practice Address - Fax:916-609-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3999OtherMHA-III