Healthcare Provider Details

I. General information

NPI: 1780549014
Provider Name (Legal Business Name): COUNTY OF RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 FULLERTON AVE STE 300
CORONA CA
92881-3106
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 951-358-5222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER LYNN CRUIKSHANK
Title or Position: CEO
Credential:
Phone: 951-486-4458