Healthcare Provider Details

I. General information

NPI: 1205968617
Provider Name (Legal Business Name): RIVERSIDE COUNTY DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ORANGE ST
RIVERSIDE CA
92501-3613
US

IV. Provider business mailing address

4275 LEMON ST SUITE 207
RIVERSIDE CA
92501-3844
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberRN524630
License Number StateCA

VIII. Authorized Official

Name: MS. ISABEL G RACATAIAN
Title or Position: RN III
Credential: BSN
Phone: 951-955-4545