Healthcare Provider Details

I. General information

NPI: 1972755296
Provider Name (Legal Business Name): RIVERSIDE COUNTY - HEMET MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N STATE ST
HEMET CA
92543-2960
US

IV. Provider business mailing address

19417 ROTTERDAM
RIVERSIDE CA
92508-6179
US

V. Phone/Fax

Practice location:
  • Phone: 951-791-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIEJOSE BALLEZA RUIZ
Title or Position: MENTAL HEALTH PEER SPECIALIST
Credential:
Phone: 619-847-7051