PROVIDENCE RECOVERY CENTERS, INC. (NPI# 1114549144) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114549144 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE RECOVERY CENTERS, INC. |
| Practice Address |
11165 Bonnie View Ave Moreno Valley CA 92555 |
| Mailing Address |
28728 Kalmia Ave Moreno Valley CA 92555 |
| Practice Telephone | 9512211805 |
| Practice Fax Number | 9514223384 |
| Mailing Telephone | 9512211805 |
| Mailing Fax Number | 9514223384 |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2020-05-13 |
| Authorized Official Name | MRS. STACY JO DORSEY (EXECUTIVE DIRECTOR/COO) |
| Authorized Official Telephone | 9512211805 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457891699 | Providence Recovery Centers, Inc. | Substance Abuse Rehabilitation Facility | 23703 Piedras Rd, Perris, CA 92570-7263 | 2017-03-07 |
| Street Address |
11165 BONNIE VIEW AVE |
| City | MORENO VALLEY |
| State | CA |
| Zip Code | 92555 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043817935 | Jillian Mika Ogata | Social Worker | Riverside University Health System, 26520 Cactus Ave., Moreno Valley, CA 92555 | 2020-10-05 |
| 1720645096 | Shahida Nawaz | Non-emergency Medical Transport (VAN) | 26528 Primrose Way, Moreno Valley, CA 92555 | 2019-05-22 |
| 1679139828 | Moses Lee | Student in an Organized Health Care Education/Training Program | Department of Orthopaedic Surgery Rm. B2042 Ruhs-mc, 26520 Cactus Ave., Moreno Valley, CA 92555 | 2019-05-14 |
| 1215419668 | Johannes Wattimena | Counselor | 26624 Saffron Circle, Moreno Valley, CA 92555 | 2018-09-02 |
| 1437676939 | Aleksandra Vargas | Behavioral Analyst | 12549 Atherton Dr, Moreno Valley, CA 92555 | 2017-08-25 |
| 1063938603 | Anthony I Odimegwu | Nurse Practitioner | 26062 Bercaw Ct, Moreno Valley, CA 92555 | 2017-08-16 |
| 1073036703 | Karen Parker | Licensed Psychiatric Technician | 12944 Dolomite Lane, Moreno Valley, CA 92555 | 2017-07-25 |
| 1861923674 | Elena Vizcaino | Behavior Technician | 15670 Turnberry St, Moreno Valley, CA 92555 | 2017-03-23 |
| 1154744522 | Nancy Chivichon | Dietitian, Registered | 28648 Avenue Ave., Moreno Valley, CA 92555 | 2014-01-21 |
| 1538581806 | Ashley Leann Abrams | Dentist | 27339 Darlene Drive, Moreno Valley, CA 92555 | 2014-01-06 |
| Find all providers in zip 92555 | ||||
| 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 |
|---|---|---|---|---|
| 1467096818 | Immanuel Sobriety Inc. | Substance Abuse Rehabilitation Facility | 23265 Park Valley Dr, Moreno Valley, CA 92553-5963 | 2019-10-29 |
| 1255823753 | Vital Treatment and Recovery Centers, Inc | Substance Abuse Rehabilitation Facility | 10467 Morning Ridge Dr, Moreno Valley, CA 92557-3211 | 2018-05-31 |
| 1639483274 | Sunrise Alcohol & Drugs Rehab Center | Substance Abuse Rehabilitation Facility | 12125 Day St Ste E315, Moreno Valley, CA 92557-6735 | 2010-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801497359 | California Care Detox & Treatment | Substance Abuse Rehabilitation Facility | 25542 Dana Mesa Dr, San Juan Capistrano, CA 92675-4311 | 2020-11-02 |
| 1952900797 | A Sacred Path | Substance Abuse Rehabilitation Facility | 5671 Spanish Flat Rd, Garden Valley, CA 95633 | 2020-10-22 |
| 1467051672 | Spearhead Health Centers, LLC. | Substance Abuse Rehabilitation Facility | 11704 Wilshire Blvd Ste 226, Los Angeles, CA 90025-1504 | 2020-10-19 |
| 1073111613 | A Place To Heal | Substance Abuse Rehabilitation Facility | 14540 Hamlin St Ste H, Van Nuys, CA 91411-4153 | 2020-10-15 |
| 1871191569 | Old Oak Ranch Recovery Center | Substance Abuse Rehabilitation Facility | 19401 Susan Way, Sonora, CA 95370-9266 | 2020-10-14 |
| 1962009845 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 9952 Grandview Dr, La Mesa, CA 91941-6874 | 2020-10-05 |
| 1376140384 | Magic House Recovery Inc | Substance Abuse Rehabilitation Facility | 1001 S Mountvale Ct, Anaheim, CA 92808-2108 | 2020-10-02 |
| 1942807060 | New Perceptions North, LLC | Substance Abuse Rehabilitation Facility | 5084 N Fruit Ave Ste 105, Fresno, CA 93711-3000 | 2020-10-01 |
| 1346857679 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 3480 Hidden Trail Dr, Jamul, CA 91935-2104 | 2020-09-30 |
| 1992312227 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 2810 Camino Del Rio S Ste 106, San Diego, CA 92108-3819 | 2020-09-30 |
| Find all providers with the same taxonomy | ||||
| City | MORENO VALLEY |
| Zip Code | 92555 |
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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.