WHITESIDE MANOR PALM FACILITY NPI 1467902502

NPI Information

WHITESIDE MANOR, PALM FACILITY is a substance abuse rehabilitation facility in Riverside, CA. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. WHITESIDE MANOR, PALM FACILITY NPI is 1467902502. The provider is registered as an organization entity type.

The provider's business location address is:

4750 PALM AVE
RIVERSIDE, CA
ZIP 92501-012
Phone: (951) 788-9515

The provider's authorized official is Dori Dotson .
The authorized official title is Administrative Manager and has the following contact phone number (951) 847-8010.

The CLIA number assigned to this NPI record is 05D2275665 - other - residentiail treatment with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/13/2016 and was last updated on 10/13/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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