Organization
HARVEST SAFE HAVEN FOR BOYS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL PARK (EXECUTIVE DIRECTOR)
(951) 295-8239
Entity
Organization
Contact information
Practice address
5425 SIERRA VISTA AVE, RIVERSIDE, CA 92505-3113
(951) 715-3126
(951) 531-8605
Mailing address
3380 LA SIERRA AVE STE 104-242, RIVERSIDE, CA 92503-5271
(951) 715-3126
(951) 531-8605
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/28/2020
Last updated
07/28/2020
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