Healthcare Provider Details

I. General information

NPI: 1346353679
Provider Name (Legal Business Name): COUNTY OF RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 E WILLIAMS ST STE 102
BANNING CA
92220-5848
US

IV. Provider business mailing address

7888 MISSION GROVE PKWY S STE 120
RIVERSIDE CA
92508-5064
US

V. Phone/Fax

Practice location:
  • Phone: 951-849-6794
  • Fax: 951-849-0060
Mailing address:
  • Phone: 951-849-6749
  • Fax: 951-498-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number250000534
License Number StateCA

VIII. Authorized Official

Name: JENNIFER CRUIKSHANK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: R.N., MSN
Phone: 951-486-6698