Healthcare Provider Details

I. General information

NPI: 1659441251
Provider Name (Legal Business Name): RIVERSIDE COUNTY DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
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

PO BOX 97
MORENO VALLEY CA
92556-0097
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-4545
  • Fax:
Mailing address:
  • Phone: 951-601-1171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberASW16621
License Number StateCA

VIII. Authorized Official

Name: MR. EDWARD PEREZ
Title or Position: MENTAL HEALTH SERVICES SUPERVISOR
Credential: MHSS
Phone: 951-955-8540