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Organization
THE CAROLYN E. WYLIE CENTER
Active
Organization
THE CAROLYN E. WYLIE CENTER
Active
Other names
The Wylie Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICKEY RUBINSON (C.E.O.)
(951) 683-5193
Entity
Organization
Contact information
Practice address
4164 BROCKTON AVE, RIVERSIDE, CA 92501-3400
(951) 683-5193
(951) 683-6019
Mailing address
4164 BROCKTON AVE, RIVERSIDE, CA 92501-3400
(951) 683-5193
(951) 683-6019
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33BA00
OTHER
CA
01
—
33BAA0
OTHER
CA
Enumeration date
03/16/2007
Last updated
08/11/2021
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