Provider Demographics
NPI:1710361688
Name:COUNTY OF RIVERSIDE
Entity Type:Organization
Organization Name:COUNTY OF RIVERSIDE
Other - Org Name:TEMECULA SU DAY REPORTING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MENTAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WENGERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-358-4500
Mailing Address - Street 1:4095 COUNTY CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3410
Mailing Address - Country:US
Mailing Address - Phone:951-358-6900
Mailing Address - Fax:
Practice Address - Street 1:41002 COUNTY CENTER DR
Practice Address - Street 2:STE. A
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6051
Practice Address - Country:US
Practice Address - Phone:951-955-1503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00033OtherLEGAL ENTITY