NPIMap

Organization Active NPI

Whiteside Manor, Palm Facility

  • Substance Abuse Rehabilitation Facility
  • Riverside, CA
National Provider Identifier
1467902502
Registry record updated Oct 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
WHITESIDE MANOR, PALM FACILITY
Practice address
4750 Palm Ave
Riverside, CA 92501-4012
Phone
(951) 788-9515
NPI assigned
Oct 13, 2016
Organization subpart
Yes
Parent organization
WHITESIDE MANORAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 13, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dori Dotson
Title
Administrative Manager
Phone
(951) 847-8010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

4750 Palm Ave
Riverside, CA 92501-4012

Mailing address

2743 Orange St
Riverside, CA 92501-2538
Phone (951) 788-9515

National Provider Directory

National Provider Directory
Tax ID family
Whiteside Manor Palm Facility4 organizations share this tax ID, including this one
Part of
Whiteside Manor Palm Facility

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2743 Orange St
Riverside, CA 92501
Phone (951) 788-9515

4750 Palm Ave
Riverside, CA 92501
Phone (800) 300-7326

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476316800000",
    "number": "1467902502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2743 ORANGE ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925012538",
            "telephone_number": "951-788-9515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4750 PALM AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925014012",
            "telephone_number": "951-788-9515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITESIDE MANOR, PALM FACILITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHITESIDE MANOR",
        "enumeration_date": "2016-10-13",
        "last_updated": "2016-10-13",
        "status": "A",
        "authorized_official_last_name": "DOTSON",
        "authorized_official_first_name": "DORI",
        "authorized_official_title_or_position": "ADMINISTRATIVE MANAGER",
        "authorized_official_telephone_number": "951-847-8010"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.