HEALING WATERS RECOVERY PALM DR, LLC (NPI# 1043760507) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043760507 |
| Entity Type | Organization |
| Organization Name | HEALING WATERS RECOVERY PALM DR, LLC |
| Practice Address |
19069 Van Buren Blvd 114 116 Riverside CA 92508-9169 |
| Mailing Address |
11220 Palm Dr Desert Hot Springs CA 92240-3163 |
| Practice Telephone | 7722330677 |
| Mailing Telephone | 7606769564 |
| Enumeration Date | 2016-10-09 |
| Last Update Date | 2016-10-09 |
| Authorized Official Name | MRS. DARLENE MARIE LEON (PRESIDENT) |
| Authorized Official Telephone | 7722330677 |
| Is Organization Subpart | Y |
| Parent Organization Name | HEALING WATERS RECOVERY DHS, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 201617610562 | CA | Residential Treatment Facilities |
| Street Address |
19069 VAN BUREN BLVD 114 116 |
| City | RIVERSIDE |
| State | CA |
| Zip Code | 92508-9169 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497774939 | Bobbie Elaine Hall | Chiropractor | 19069 Van Buren Blvd, #110, Riverside, CA 92508-9152 | 2006-07-18 |
| 1639379233 | Daniel C Chang | Emergency Medicine | 19069 Van Buren Blvd, Ste 114-427, Riverside, CA 92508-9169 | 2007-07-20 |
| 1962581918 | Lisa R Romero | Social Worker | 19069 Van Buren Blvd, Ste 114-223, Riverside, CA 92508-9169 | 2006-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699257121 | Careconnexus, LLC | Non-emergency Medical Transport (VAN) | 9338 Millionaire Lane, Riverside, CA 92508 | 2018-08-31 |
| 1003265117 | Travis William Cruz | Physician Assistant | 9525 Los Amigos Court, Riverside, CA 92508 | 2016-06-09 |
| 1043610769 | Mountain Vista Medical Center | General Acute Care Hospital | 8168 Palm View Ln, Riverside, CA 92508 | 2014-08-29 |
| 1952642399 | John Lawrence Bowers | Marriage & Family Therapist | 19900 Grove Community Drive, Riverside, CA 92508 | 2013-03-11 |
| 1952605248 | Dennis Graves | Counselor | 17270 Roosevelt Ave, Riverside, CA 92508 | 2011-01-01 |
| 1811207632 | Bekele T Haimanot | Physician Assistant | 9528 Los Coches Court, Riverside, CA 92508 | 2010-10-14 |
| 1518144625 | Irene T. Zaki | Dentist | 20873 Grove Community Dr., Riverside, CA 92508 | 2008-01-31 |
| 1093902447 | Edward Keith Forward | Specialist | 18167 Kross Rd, Riverside, CA 92508 | 2007-10-01 |
| 1255523593 | Sopheap Tang | Dentist | 18876 Van Buren Blvd, Ste 107, Riverside, CA 92508 | 2007-08-10 |
| 1942336995 | Ching-roo Chi | Dentist | 473 E. Allessandro Blvd., Suite A, Riverside, CA 92508 | 2007-02-26 |
| Find all providers in zip 92508 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| 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. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437794252 | Promising Outlook | Substance Abuse Rehabilitation Facility | 4136 10th St, Riverside, CA 92501-3110 | 2019-11-15 |
| 1508372186 | Whiteside Manor, Inc. | Substance Abuse Rehabilitation Facility | 2759 Orange St, Riverside, CA 92501-2538 | 2017-12-19 |
| 1487177374 | Everlast Recovery Centers Inc | Substance Abuse Rehabilitation Facility | 6560 Sandy Ln, Riverside, CA 92505-2028 | 2017-07-21 |
| 1841664885 | Jacqueline Garcia | Substance Abuse Rehabilitation Facility | 10371 Hole Ave, Riverside, CA 92505-1747 | 2015-11-13 |
| 1952706319 | House On The Corner LLC The | Substance Abuse Rehabilitation Facility | 2709 Orange St, Riverside, CA 92501-2538 | 2014-10-28 |
| 1578962114 | Bluestone Recovery, Inc. | Substance Abuse Rehabilitation Facility | 1660 Chicago Ave Ste M11, Riverside, CA 92507-2033 | 2014-08-20 |
| 1053724716 | 10 Acre Ranch | Substance Abuse Rehabilitation Facility | 8605 Janet Ave, Riverside, CA 92503-9212 | 2014-06-10 |
| 1598002123 | Big Bear Recovery Center | Substance Abuse Rehabilitation Facility | 16891 Alita Dr, Riverside, CA 92504-6209 | 2013-01-16 |
| 1376714048 | Mfi Recovery Center | Substance Abuse Rehabilitation Facility | 9999 County Farm Rd, Riverside, CA 92503-3506 | 2008-03-20 |
| 1285802165 | Pavisch Treatment Centers, LLC | Substance Abuse Rehabilitation Facility | 4241 Glenwood Dr, Riverside, CA 92501-3027 | 2008-02-13 |
| Find all providers in RIVERSIDE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.