Provider Demographics
NPI:1598864357
Name:WHITESIDE MANOR, INC.
Entity Type:Organization
Organization Name:WHITESIDE MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORI
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-788-9515
Mailing Address - Street 1:2743 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-2538
Mailing Address - Country:US
Mailing Address - Phone:951-686-9454
Mailing Address - Fax:951-686-2303
Practice Address - Street 1:2743 ORANGE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-2538
Practice Address - Country:US
Practice Address - Phone:951-686-9454
Practice Address - Fax:951-686-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility