Provider Demographics
NPI:1982703773
Name:RIVERSIDE RECOVERY RESOURCES
Entity Type:Organization
Organization Name:RIVERSIDE RECOVERY RESOURCES
Other - Org Name:OMEGA/BETA PROGRAM
Other - Org Type:Doing Business As
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:II
Authorized Official - Credentials:
Authorized Official - Phone:951-674-5354
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:951-674-5354
Mailing Address - Fax:951-674-5227
Practice Address - Street 1:600 THIRD STREET
Practice Address - Street 2:STE C
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-0000
Practice Address - Country:US
Practice Address - Phone:951-674-5354
Practice Address - Fax:951-674-5227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3300090N251300000X
CA330009ON251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)