Provider Demographics
NPI:1427272194
Name:RIVERSIDE COUNTY DEPT. OF MENTAL HEALTH SUBSTANCE ABUSE PROGRAM
Entity type:Organization
Organization Name:RIVERSIDE COUNTY DEPT. OF MENTAL HEALTH SUBSTANCE ABUSE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH SPECIALIST III
Authorized Official - Prefix:MR
Authorized Official - First Name:NOE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-863-8759
Mailing Address - Street 1:46200 OASIS ST
Mailing Address - Street 2:RM. 106
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5933
Mailing Address - Country:US
Mailing Address - Phone:760-863-8759
Mailing Address - Fax:760-863-8755
Practice Address - Street 1:46200 OASIS ST
Practice Address - Street 2:RM. 106
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5933
Practice Address - Country:US
Practice Address - Phone:760-863-8759
Practice Address - Fax:760-863-8755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health