NPIMap

Organization Active NPI

County of Riverside

Doing business as Lake Elsinore Adult Clinic

  • Community/Behavioral Health Agency
  • Lake Elsinore, CA
National Provider Identifier
1871924928
Registry record updated Sep 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COUNTY OF RIVERSIDE
Doing business as
Lake Elsinore Adult Clinic
Practice address
31760 & 31764 Casino Dr
Lake Elsinore, CA 92530-4561
Phone
(951) 943-8015
NPI assigned
Nov 27, 2013
Last updated
Sep 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Matthew Chang
Title
Director Ruhs - Behavioral Health
Phone
(951) 358-4500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

31760 & 31764 Casino Dr
Lake Elsinore, CA 92530-4561

Mailing address

4095 County Circle Dr
Riverside, CA 92503-3410
Phone (951) 358-6900

Other identifiers 1

IdentifierTypeStateIssuer
00033OtherLEGAL ENTITY

Other names 1

  • Lake Elsinore Adult Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310001107 CA Part B Supplier - Clinic/Group Practice 6507754488 Receives reassigned benefits from 362 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Riverside Neighborhood244 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662681600000",
    "number": "1871924928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4095 COUNTY CIRCLE DR",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033410",
            "telephone_number": "951-358-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31760 & 31764 CASINO DR",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925304561",
            "telephone_number": "951-943-8015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF RIVERSIDE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-27",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "DIRECTOR RUHS - BEHAVIORAL HEALTH",
        "authorized_official_telephone_number": "951-358-4500",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LEGAL ENTITY",
            "identifier": "00033",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Elsinore Adult Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Elsinore Adult Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Elsinore, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.