Organization
PROVIDENCE RECOVERY CENTERS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACY JO DORSEY (EXECUTIVE DIRECTOR/COO)
(951) 221-1805
Entity
Organization
Contact information
Practice address
11165 BONNIE VIEW AVE, MORENO VALLEY, CA 92555
(951) 221-1805
(951) 422-3384
Mailing address
28728 KALMIA AVE, MORENO VALLEY, CA 92555
(951) 221-1805
(951) 422-3384
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
05/13/2020
Last updated
05/13/2020
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