Organization
CHANGE THE INFLUENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MERCEDES MONTANA (CEO)
(760) 636-9226
Entity
Organization
Contact information
Practice address
16801 VAN BUREN BLVD, RIVERSIDE, CA 92504-5896
(760) 636-9226
Mailing address
16801 VAN BUREN BLVD, RIVERSIDE, CA 92504-5896
(760) 636-9226
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
07/07/2021
Last updated
07/08/2021
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