Healthcare Provider Details

I. General information

NPI: 1659419588
Provider Name (Legal Business Name): DOMH RIVERSIDE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

4275 LEMON ST SUITE 207
RIVERSIDE CA
92501-3844
US

IV. Provider business mailing address

4275 LEMON ST SUITE 207
RIVERSIDE CA
92501-3844
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-4534
  • Fax: 951-955-2138
Mailing address:
  • Phone: 951-955-4534
  • Fax: 951-955-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number498613
License Number StateCA

VIII. Authorized Official

Name: MS. EVA MAE CURTIS
Title or Position: RN
Credential:
Phone: 951-955-4545