Provider Demographics
NPI:1588781066
Name:RIVERSIDE MENTAL HEALTH
Entity type:Organization
Organization Name:RIVERSIDE MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL STUDENT INTERN
Authorized Official - Prefix:
Authorized Official - First Name:MARISELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-358-4390
Mailing Address - Street 1:2531 NORTH REDLANDS AVENUE
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-4021
Mailing Address - Country:US
Mailing Address - Phone:951-943-6936
Mailing Address - Fax:
Practice Address - Street 1:10000 COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3508
Practice Address - Country:US
Practice Address - Phone:951-358-4472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness