Healthcare Provider Details

I. General information

NPI: 1245652437
Provider Name (Legal Business Name): RIVERSIDE COUNTY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 BLAINE ST SUITE B
RIVERSIDE CA
92507
US

IV. Provider business mailing address

769 BLAINE ST SUITE B
RIVERSIDE CA
92507
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4705
  • Fax: 951-358-4719
Mailing address:
  • Phone: 951-358-4705
  • Fax: 951-358-4719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUCY R AHUMADA
Title or Position: SUPERVISOR
Credential:
Phone: 951-358-4705