Healthcare Provider Details

I. General information

NPI: 1619159506
Provider Name (Legal Business Name): RIVERSIDE COUNTY DEPT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 CHICAGO AVE
RIVERSIDE CA
92507-3448
US

IV. Provider business mailing address

PO BOX 7659
RIVERSIDE CA
92513
US

V. Phone/Fax

Practice location:
  • Phone: 951-341-6440
  • Fax: 951-341-6403
Mailing address:
  • Phone: 951-358-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JERRY WENGERD
Title or Position: DIRECTOR OF MENTAL HEALTH
Credential:
Phone: 951-358-4500