Provider Demographics
NPI:1710189352
Name:RIVERSIDE USD
Entity Type:Organization
Organization Name:RIVERSIDE USD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELPA DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:MORFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-788-7142
Mailing Address - Street 1:6050 INDUSTRIAL AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-1127
Mailing Address - Country:US
Mailing Address - Phone:951-352-6723
Mailing Address - Fax:
Practice Address - Street 1:6050 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-1127
Practice Address - Country:US
Practice Address - Phone:951-352-6723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS3367215Medicaid