Provider Demographics
NPI:1235675646
Name:RIVERSIDE COUNTY LATINO COMMISSION ON ALCOHOL AND DRUG ABUSE SERVICES
Entity Type:Organization
Organization Name:RIVERSIDE COUNTY LATINO COMMISSION ON ALCOHOL AND DRUG ABUSE SERVICES
Other - Org Name:MICHAEL'S YOUTH TREATMENT HOME FOR BOYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-398-9000
Mailing Address - Street 1:1612 1ST ST
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-1407
Mailing Address - Country:US
Mailing Address - Phone:760-398-9000
Mailing Address - Fax:760-398-9790
Practice Address - Street 1:43485 HOLLYHOCK ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-1976
Practice Address - Country:US
Practice Address - Phone:760-398-8800
Practice Address - Fax:760-398-9790
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERSIDE COUNTY LATINO COMMISSION ON ALCOHOL AND DRUG ABUSE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-09
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children