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	00033	OTHER	CA	LEGAL ENTITY

General Provider Information

NPI Number	:	1164795621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF RIVERSIDE

Provider Business Mailing Address
First Line	:	PO BOX 7659
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	771 W BLAINE ST
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-3940
Country	:	US
Telephone Number	:	951-933-8000
Fax Number	:

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

Provider Enumeration Date	:	02/14/2012
Last Update Date	:	09/09/2022

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Directions to “COUNTY OF RIVERSIDE ” Practice Location

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