Healthcare Provider Details

I. General information

NPI: 1588781066
Provider Name (Legal Business Name): RIVERSIDE MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 COUNTY FARM RD
RIVERSIDE CA
92503-3508
US

IV. Provider business mailing address

2531 NORTH REDLANDS AVENUE
PERRIS CA
92571-4021
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4472
  • Fax:
Mailing address:
  • Phone: 951-943-6936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MARISELA GUTIERREZ
Title or Position: PROFESSIONAL STUDENT INTERN
Credential:
Phone: 951-358-4390