Healthcare Provider Details

I. General information

NPI: 1679748289
Provider Name (Legal Business Name): COUNTY OF RIVERSIDE DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3768 10TH ST
RIVERSIDE CA
92501-3621
US

IV. Provider business mailing address

PO BOX 7549
RIVERSIDE CA
92513-7549
US

V. Phone/Fax

Practice location:
  • Phone: 951-328-1594
  • Fax: 951-275-0527
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 StateCA

VIII. Authorized Official

Name: MR. JERRY A WENGERD
Title or Position: DIRECTOR, DEPT. OF MENTAL HEALTH
Credential:
Phone: 951-358-4500