Healthcare Provider Details

I. General information

NPI: 1053451047
Provider Name (Legal Business Name): RIVERSIDE CO. DEPT. OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 LEMON ST
RIVERSIDE CA
92501-3844
US

IV. Provider business mailing address

511 SPRUCE ST
RIVERSIDE CA
92507-3044
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-4545
  • Fax:
Mailing address:
  • Phone: 951-684-2882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number350830
License Number StateCA

VIII. Authorized Official

Name: MRS. BARBARA J. BOOKER
Title or Position: PSYCHIATRIC RN III
Credential: RN
Phone: 951-684-2882