Healthcare Provider Details

I. General information

NPI: 1982224168
Provider Name (Legal Business Name): COUNTY OF RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11060 MAGNOLIA AVE
RIVERSIDE CA
92505-3047
US

IV. Provider business mailing address

4095 COUNTY CIRCLE DR
RIVERSIDE CA
92503-3410
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-6726
  • Fax:
Mailing address:
  • Phone: 351-358-6900
  • Fax:

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: MATTHEW CHANG
Title or Position: DIRECTOR RUHS - BEHAVIORAL HEALTH
Credential:
Phone: 951-358-4500