Provider Demographics
NPI:1578603130
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:REGISTERED NURSE III
Authorized Official - Prefix:MISS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:T
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:714-848-0585
Mailing Address - Street 1:8567 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5541
Mailing Address - Country:US
Mailing Address - Phone:714-848-0585
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:951-955-8541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA554402251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management