Basic Information
| Provider Information | |||||||||
| NPI: | 1861875924 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UCR HEALTH - RIVERSIDE COUNTY MENTAL HEALTH DEPT. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 31001-2130 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911102130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134121973 | ||||||||
| FaxNumber: | 2134121981 | ||||||||
| Practice Location | |||||||||
| Address1: | 4095 COUNTY CIRCLE DR | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925033410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513586008 | ||||||||
| FaxNumber: | 9513584513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2015 | ||||||||
| LastUpdateDate: | 07/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | HEYDT | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7144562986 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | REGENTS OF THE UNIVERSITY OF CALIFORNIA | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.