| County Of Riverside | |
|
5256 Mission Blvd Riverside CA 92509-4611 | |
| (951) 955-0840 | |
| (951) 955-5317 |
| Full Name | County Of Riverside |
|---|---|
| Speciality | Public Health or Welfare |
| Location | 5256 Mission Blvd, Riverside, California |
| Authorized Official Name and Position | Koen Brown (DEPUTY DIRECTOR II) |
| Authorized Official Contact | 9513585222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| County Of Riverside Po Box 7849 Riverside CA 92513-7849 Ph: (951) 358-5222 | County Of Riverside 5256 Mission Blvd Riverside CA 92509-4611 Ph: (951) 955-0840 |
| NPI Number | 1356455299 |
|---|---|
| Provider Enumeration Date | 08/18/2006 |
| Last Update Date | 06/11/2009 |
| Medicare PECOS PAC ID | 6507754488 |
|---|---|
| Medicare Enrollment ID | O20140425001105 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356455299 | NPI | - | NPPES |
| EXE70155F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (California) | Secondary |
| 251K00000X | Public Health Or Welfare | (California) | Primary |
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