Healthcare Provider Details

I. General information

NPI: 1578603130
Provider Name (Legal Business Name): RIVERSIDE CO. DEPT. OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 LEMON ST
RIVERSIDE CA
92501-3844
US

IV. Provider business mailing address

8567 SHADOW LN
FOUNTAIN VALLEY CA
92708-5541
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-8541
  • Fax:
Mailing address:
  • Phone: 714-848-0585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number554402
License Number StateCA

VIII. Authorized Official

Name: MISS MONIQUE T. LE
Title or Position: REGISTERED NURSE III
Credential: BSN
Phone: 714-848-0585