Provider Demographics
NPI:1992890305
Name:VALLEY WIDE RECREATION & PARK DISTRICT
Entity type:Organization
Organization Name:VALLEY WIDE RECREATION & PARK DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-654-1505
Mailing Address - Street 1:P.O. BOX 907
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92581
Mailing Address - Country:US
Mailing Address - Phone:951-654-1505
Mailing Address - Fax:951-654-9927
Practice Address - Street 1:901 W. ESPLANADE AVE.
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582
Practice Address - Country:US
Practice Address - Phone:951-654-1505
Practice Address - Fax:951-654-9927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330046AN3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children