Provider Demographics
NPI:1669602843
Name:HIGHRIDGE FACILITY
Entity type:Organization
Organization Name:HIGHRIDGE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QA
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRLETICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-565-8144
Mailing Address - Street 1:1230 HIGHRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-5771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1230 HIGHRIDGE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-5771
Practice Address - Country:US
Practice Address - Phone:951-565-8144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIDGES IN COMMUNICATIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3364033240261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities