MEDICARE: COUNTY OF RIVERSIDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3315	OTHER	CA	STATE PROVIDER
2	00033	OTHER	CA	LEGAL ENTITY

General Provider Information

NPI Number	:	1063528891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF RIVERSIDE

Provider Business Mailing Address
First Line	:	PO BOX 7549
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92513-7549
Country	:	US
Telephone Number	:	951-358-6900
Fax Number	:	951-358-6905

Provider Business Practice Location Address
First Line	:	769 W BLAINE ST
Second Line	:	SUITE B
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-3970
Country	:	US
Telephone Number	:	951-358-4705
Fax Number	:	951-358-4719

Authorized Official
Title or Position	:	DIRECTOR OF RUHS-BEHAVIORAL HEALTH
Name	:	DR. MATTHEW CHANG
Credential	:
Telephone Number	:	951-358-4500

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	10/12/2022

Similar Medicare Providers

1295984417 — MRS. LINDA KAY RABER MFCC CA LIC # 20028
Practice Location Address:

769 W BLAINE ST STE B
RIVERSIDE, CA
92507-3970

Practice Phone: 951-358-4523
Practice Fax:

1043203466 — ARTHUR AMADOR MD
Practice Location Address:

769 W BLAINE ST STE B
RIVERSIDE, CA
92507-3970

Practice Phone: 951-358-4705
Practice Fax: 951-358-4719

1669434361 — DR. PAYTON GORDON BROWN MD
Practice Location Address:

769 W BLAINE ST STE B
RIVERSIDE, CA
92507-3970

Practice Phone: 951-358-4705
Practice Fax: 513-584-7199

1922119056 — MRS. STARR ALINE RAMIREZ LCSW
Practice Location Address:

769 W BLAINE ST , STE. A
RIVERSIDE, CA
92507-3970

Practice Phone: 951-358-6895
Practice Fax:

1033211610 — LILA SAMADY LCSW
Practice Location Address:

769 W BLAINE ST
RIVERSIDE, CA
92507-3970

Practice Phone: 951-358-6895
Practice Fax:

1508958182 — MR. GEORGE WILLIAMSON CUMMING III MA, MFTI
Practice Location Address:

769 W BLAINE ST , SUITE B
RIVERSIDE, CA
92507-3970

Practice Phone: 951-358-4705
Practice Fax: 951-358-4719

Directions to “COUNTY OF RIVERSIDE ” Practice Location

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