Provider Demographics
NPI:1760932354
Name:COUNTY OF RIVERSIDE
Entity Type:Organization
Organization Name:COUNTY OF RIVERSIDE
Other - Org Name:MENTAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:LVN
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLISE
Authorized Official - Middle Name:CORDELIA
Authorized Official - Last Name:HUCAKABEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-600-6355
Mailing Address - Street 1:41002 COUNTY CENTER DR
Mailing Address - Street 2:STE#320
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6051
Mailing Address - Country:US
Mailing Address - Phone:951-600-0635
Mailing Address - Fax:
Practice Address - Street 1:41002 COUNTY CENTER DR
Practice Address - Street 2:STE#320
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6051
Practice Address - Country:US
Practice Address - Phone:951-600-0635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN209162251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health