Healthcare Provider Details

I. General information

NPI: 1144101486
Provider Name (Legal Business Name): COUNTY OF RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 COUNTY CIRCLE DRIVE
RIVERSIDE CA
92503
US

IV. Provider business mailing address

4060 COUNTY CIRCLE DRIVE
RIVERSIDE CA
92503
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-3030
  • Fax:
Mailing address:
  • Phone: 951-358-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHARITY DOUGLAS
Title or Position: DIRECTOR OF DEPARTMENT OF PUBLIC SO
Credential:
Phone: 951-358-6995