Healthcare Provider Details

I. General information

NPI: 1285709139
Provider Name (Legal Business Name): COUNTY OF RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 ATLANTA AVE SUITE D3
RIVERSIDE CA
92507-7419
US

IV. Provider business mailing address

PO BOX 7549
RIVERSIDE CA
92513-7549
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-8000
  • Fax: 951-955-8010
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: MR. JERRY A WENGERD
Title or Position: DIRECTOR, DEPT. OF MENTAL HEALTH
Credential:
Phone: 951-358-4501