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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00033	OTHER	CA	LEGAL ENTITY

General Provider Information

NPI Number	:	1346315389
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	:	3125 MYERS ST
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-5527
Country	:	US
Telephone Number	:	951-358-6858
Fax Number	:	951-687-3478

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	10/13/2022

Similar Medicare Providers

1407968068 — DR. RICHARD JOONKOO LEE M.D.
Practice Location Address:

3125 MYERS ST , RCDMH CHILDREN'S TREATMENT SERVICES
RIVERSIDE, CA
92503-5527

Practice Phone: 951-358-4840
Practice Fax: 951-358-4848

1366534984 — MRS. ESTHER CUEVAS MCCOY L.C.S.W.
Practice Location Address:

3125 MYERS ST
RIVERSIDE, CA
92503-5527

Practice Phone: 951-358-4850
Practice Fax: 951-358-4852

1033202122 — MRS. APRIL DYANN SHORTERS M.S.
Practice Location Address:

3125 MYERS ST
RIVERSIDE, CA
92503-5527

Practice Phone: 951-358-3510
Practice Fax:

1285722827 — NICHOL MARIE SPAINHOWER
Practice Location Address:

3125 MYERS ST BLDG 3
RIVERSIDE, CA
92503-5527

Practice Phone: 951-358-5810
Practice Fax:

1306911250 — COUNTY OF RIVERSIDE
Practice Location Address:

3125 MYERS ST
RIVERSIDE, CA
92503-5527

Practice Phone: 951-358-4850
Practice Fax: 951-358-4852

1407921356 — COUNTY OF RIVERSIDE
Practice Location Address:

3125 MYERS ST
RIVERSIDE, CA
92503-5527

Practice Phone: 951-341-8830
Practice Fax: 951-387-3478

Directions to “COUNTY OF RIVERSIDE ” Practice Location

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