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2020 Iowa Ave Ste 101 Riverside CA 92507-7428 | |
| (951) 436-5300 | |
| (951) 436-5350 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2020 Iowa Ave Ste 101, Riverside, California |
| Authorized Official Name and Position | Angie R Wiechert (DIRECTOR OF FINANCIAL ANALYSIS) |
| Authorized Official Contact | 5302301210 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1360 E Lassen Ave Chico CA 95973-7823 Ph: (530) 893-0758 | 2020 Iowa Ave Ste 101 Riverside CA 92507-7428 Ph: (951) 436-5300 |
| NPI Number | 1487490397 |
|---|---|
| Provider Enumeration Date | 07/02/2024 |
| Last Update Date | 12/18/2024 |
| Certification Date | 12/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487490397 | NPI | - | NPPES |
| 01042 | Other | CA | LEGAL ENTITY # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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