Provider Demographics
NPI:1740402783
Name:COUNTY OF RIVERSIDE
Entity Type:Organization
Organization Name:COUNTY OF RIVERSIDE
Other - Org Name:CHILDREN'S DENTAL DISEASE PREVENTION PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:951-358-7036
Mailing Address - Street 1:PO BOX 7600
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92513-7600
Mailing Address - Country:US
Mailing Address - Phone:951-358-7251
Mailing Address - Fax:951-358-5002
Practice Address - Street 1:3900 SHERMAN DR
Practice Address - Street 2:SUITE G
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4005
Practice Address - Country:US
Practice Address - Phone:951-358-7251
Practice Address - Fax:951-358-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare