Organization
COUNTY OF RIVERSIDE
Active
Other names
New Life SU - Indio Probation
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY WENGERD (DIRECTOR OF MENTAL HEALTH)
(951) 358-4500
Entity
Organization
Contact information
Practice address
47940 ARABIA ST, INDIO, CA 92201-6828
(951) 955-1503
Mailing address
4095 COUNTY CIRCLE DR, RIVERSIDE, CA 92503-3410
(951) 358-6900
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00033
LEGAL ENTITY
CA
Enumeration date
11/04/2015
Last updated
11/04/2015
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