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Organization
RIVERSIDE SUPPORTIVE LIVING
Active
Organization
RIVERSIDE SUPPORTIVE LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE B MAYO (PRESIDENT)
(951) 203-2892
Entity
Organization
Contact information
Practice address
12245 AVOCADO LN, RIVERSIDE, CA 92503-6563
(951) 203-2892
(951) 343-0034
Mailing address
12245 AVOCADO LN, RIVERSIDE, CA 92503-6563
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
026756
CA
Other
Enumeration date
03/22/2009
Last updated
03/22/2009
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