Provider Demographics
NPI:1245553700
Name:RIVERSIDE COUNTY SUBSTANCE ABUSE PROGRAM
Entity type:Organization
Organization Name:RIVERSIDE COUNTY SUBSTANCE ABUSE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:THIEM
Authorized Official - Suffix:
Authorized Official - Credentials:RAS
Authorized Official - Phone:951-600-6360
Mailing Address - Street 1:41002 COUNTY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6027
Mailing Address - Country:US
Mailing Address - Phone:951-600-6360
Mailing Address - Fax:
Practice Address - Street 1:41002 COUNTY CENTER DR.
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:951-600-6360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330023DN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health