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	3313	OTHER	CA	STATE PROVIDER
2	00033	OTHER	CA	LEGAL ENTITY

General Provider Information

NPI Number	:	1780790436
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	:	9990 COUNTY FARM RD
Second Line	:	SUITES 3-4
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-3542
Country	:	US
Telephone Number	:	951-358-4700
Fax Number	:	951-358-4730

Authorized Official
Title or Position	:	DIRECTOR 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

1184665150 — JOHN NOUBUEZE OJINMAH MD
Practice Location Address:

9990 COUNTY FARM RD
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92503-3542

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1427067230 — TABASSUM SABA MD
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1821108374 — NOVANH SCOTT XAYARATH MFT
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9990 COUNTY FARM RD , SUITE 5
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1760587810 — MARK GERARD CISNEROS MFT
Practice Location Address:

9990 COUNTY FARM RD , SUITE5
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Practice Fax:

1972604155 — MS. ANDREA DENISE BURT LCSW
Practice Location Address:

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1891883427 — MS. CAROLYN DOUGLAS WILLIAMS LCSW
Practice Location Address:

9990 COUNTY FARM RD
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Directions to “COUNTY OF RIVERSIDE ” Practice Location

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