Provider Demographics
NPI:1053451047
Name:RIVERSIDE CO. DEPT. OF MENTAL HEALTH
Entity Type:Organization
Organization Name:RIVERSIDE CO. DEPT. OF MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC RN III
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:951-684-2882
Mailing Address - Street 1:511 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-3044
Mailing Address - Country:US
Mailing Address - Phone:951-684-2882
Mailing Address - Fax:
Practice Address - Street 1:4275 LEMON ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3844
Practice Address - Country:US
Practice Address - Phone:951-955-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA350830310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness