Provider Demographics
NPI:1033289806
Name:COUNTY OF RIVERSIDE
Entity Type:Organization
Organization Name:COUNTY OF RIVERSIDE
Other - Org Name:DEPARTMENT OF MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, DEPT. OF MENTAL HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WENGERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-358-4500
Mailing Address - Street 1:PO BOX 7549
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92513-7549
Mailing Address - Country:US
Mailing Address - Phone:951-358-6900
Mailing Address - Fax:951-358-6905
Practice Address - Street 1:4095 COUNTY CIRCLE DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3410
Practice Address - Country:US
Practice Address - Phone:951-358-4613
Practice Address - Fax:951-358-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00033251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33BHMedicaid
CA00F33Medicaid