| Providence Community Services | |
|
3890 11th. Street Suite 118 Riverside CA 92501 | |
| (562) 467-5577 | |
| (562) 467-5553 |
| Full Name | Providence Community Services |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3890 11th. Street, Riverside, California |
| Authorized Official Name and Position | Michelle Molnar (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 5624675577 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Community Services 4281 Katella Ave Suite 201 Los Alamitos CA 90720-3500 Ph: (562) 467-5577 | Providence Community Services 3890 11th. Street Suite 118 Riverside CA 92501 Ph: (562) 467-5577 |
| NPI Number | 1255754784 |
|---|---|
| Provider Enumeration Date | 02/04/2014 |
| Last Update Date | 02/04/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255754784 | NPI | - | NPPES |
| 00 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (California) | Primary |
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