Provider Demographics
NPI:1487716619
Name:MFI RECOVERY CENTER
Entity type:Organization
Organization Name:MFI RECOVERY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSSYE
Authorized Official - Middle Name:KARIN
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-683-6596
Mailing Address - Street 1:5870 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2037
Mailing Address - Country:US
Mailing Address - Phone:951-683-6596
Mailing Address - Fax:991-351-1554
Practice Address - Street 1:5870 ARLINGTON AVE
Practice Address - Street 2:103
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504
Practice Address - Country:US
Practice Address - Phone:951-683-6596
Practice Address - Fax:951-683-4239
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MFI RECOVERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-14
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
CA330013AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA02443200Medicaid