Healthcare Provider Details

I. General information

NPI: 1770770364
Provider Name (Legal Business Name): COUNTY OF RIVERSIDE DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 COUNTY FARM RD
RIVERSIDE CA
92503-3505
US

IV. Provider business mailing address

9890 COUNTY FARM RD
RIVERSIDE CA
92503-3505
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4850
  • Fax:
Mailing address:
  • Phone: 951-358-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberD1655163
License Number StateCA

VIII. Authorized Official

Name: MRS. LIBET CASTANEDA
Title or Position: BEHAVIORAL HEALTH SPECIALIST II
Credential:
Phone: 951-358-4850