Provider Demographics
NPI:1295000750
Name:RIVERSIDE RECOVERY RESOURCES
Entity Type:Organization
Organization Name:RIVERSIDE RECOVERY RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRUAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-216-7300
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:951-216-7300
Mailing Address - Fax:951-216-7333
Practice Address - Street 1:671 N FLORIDA ST
Practice Address - Street 2:RCOE BANNING
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-5678
Practice Address - Country:US
Practice Address - Phone:951-216-7312
Practice Address - Fax:951-216-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder