Provider Demographics
NPI:1790819068
Name:RIVERSIADE COUNTY DEPT. OF MENTAL HEALTH
Entity Type:Organization
Organization Name:RIVERSIADE COUNTY DEPT. OF MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:P
Authorized Official - Last Name:FARJALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-955-4545
Mailing Address - Street 1:9461 FLICKER AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6543
Mailing Address - Country:US
Mailing Address - Phone:714-962-1040
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:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37158311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility