Healthcare Provider Details

I. General information

NPI: 1861624132
Provider Name (Legal Business Name): COUNTY OF RIVERSIDE DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9990 COUNTY FARM RD STE 6
RIVERSIDE CA
92503-3542
US

IV. Provider business mailing address

27506 HAZELHURST ST UNIT 1
MURRIETA CA
92562-2882
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-6919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRY WENGERD
Title or Position: DIRECTOR OF MENTAL HEALTH
Credential: LCSW
Phone: 951-358-4501