Healthcare Provider Details

I. General information

NPI: 1144395088
Provider Name (Legal Business Name): COUNTY OF RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 S MAIN ST FL 2
CORONA CA
92882-5942
US

IV. Provider business mailing address

3525 PRESLEY AVE
RIVERSIDE CA
92507-4453
US

V. Phone/Fax

Practice location:
  • Phone: 951-737-2962
  • Fax: 951-737-2783
Mailing address:
  • Phone: 951-782-2400
  • Fax: 951-683-4904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW CHANG
Title or Position: DIRECTOR OF BEHAVIORAL HEALTH
Credential:
Phone: 951-358-4501