Provider Demographics
NPI:1073837779
Name:RIVERSIDE RECOVERY RESOURCES
Entity Type:Organization
Organization Name:RIVERSIDE RECOVERY RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:CAS II
Authorized Official - Phone:951-674-5354
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92531-0549
Mailing Address - Country:US
Mailing Address - Phone:951-674-5354
Mailing Address - Fax:951-674-5227
Practice Address - Street 1:515 E 7TH ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-2464
Practice Address - Country:US
Practice Address - Phone:951-940-6061
Practice Address - Fax:951-674-5227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder