Provider Demographics
NPI:1932523610
Name:RIVERSIDE RECOVERY RESOURCES
Entity Type:Organization
Organization Name:RIVERSIDE RECOVERY RESOURCES
Other - Org Name:FIRST STEP HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRUAX
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:951-290-5870
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:951-290-5870
Mailing Address - Fax:951-294-5806
Practice Address - Street 1:40329 STETSON AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-7358
Practice Address - Country:US
Practice Address - Phone:951-658-4466
Practice Address - Fax:951-294-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330009FN3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330009CNOtherSTATE OF CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES LICENSE