417 South River LLC
Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children in Murrieta, CA. Organization (NPI-2).
NPI number1891571659
StatusActive
Last updated in NPPESMay 21, 2025
Details
- NPI
- 1891571659
- Entity type
- Organization (NPI-2)
- Legal business name
- 417 South River LLC
- Organization subpart
- No
- Enumeration date
- Sep 6, 2023
- Certification date
- May 21, 2025
- Last updated
- May 21, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3245S0500X | Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | – | – | Yes |
| 251S00000X | Community/Behavioral Health | – | – | |
| 261QM0855X | Clinic/Center, Adolescent and Children Mental Health | – | – |
Other names
- 417 Recovery (Doing Business As)
Practice location
33050 Antelope Rd Ste 201202Murrieta, CA 92563-2489
Phone 760-485-6563
Mailing address
33050 Antelope Rd Ste 201Murrieta, CA 92563-2491
Phone 760-485-6563
Authorized official
Stevie Kuhn
Owner/Partner
7604856563
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