Healthcare Provider Details

I. General information

NPI: 1134295702
Provider Name (Legal Business Name): COUNTY OF RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 09/02/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83912 AVENUE 45 SUITE 9
INDIO CA
92201-3338
US

IV. Provider business mailing address

4095 COUNTY CIRCLE DR
RIVERSIDE CA
92503-3410
US

V. Phone/Fax

Practice location:
  • Phone: 760-347-0754
  • Fax: 760-347-8507
Mailing address:
  • Phone: 951-358-6900
  • Fax: 951-358-6905

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: MATTHEW CHANG
Title or Position: DIRECTOR OF BEHAVIORAL HEALTH
Credential:
Phone: 951-358-4500