Healthcare Provider Details

I. General information

NPI: 1962804005
Provider Name (Legal Business Name): RIVERSIDE COUNTY MENTAL HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 MYERS ST
RIVERSIDE CA
92503-5527
US

IV. Provider business mailing address

3125 MYERS ST
RIVERSIDE CA
92503-5527
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4840
  • Fax: 951-358-4848
Mailing address:
  • Phone: 951-358-4840
  • Fax: 951-358-4848

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: MS. DANIELLE NICHOLE CASTILLO
Title or Position: PARENT PARTNER
Credential:
Phone: 951-358-4840