| Life Source Solutions, Inc | |
|
4107 Mission Inn Ave Riverside CA 92501 | |
| (951) 682-7143 | |
| (951) 684-1135 |
| Full Name | Life Source Solutions, Inc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 4107 Mission Inn Ave, Riverside, California |
| Authorized Official Name and Position | Avis C Attaway (OWNER) |
| Authorized Official Contact | 9515229370 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Source Solutions, Inc Po Box 529 Riverside CA 92501 Ph: (951) 682-7143 | Life Source Solutions, Inc 4107 Mission Inn Ave Riverside CA 92501 Ph: (951) 682-7143 |
| NPI Number | 1609004563 |
|---|---|
| Provider Enumeration Date | 06/30/2009 |
| Last Update Date | 06/30/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609004563 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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