Healthcare Provider Details

I. General information

NPI: 1780521534
Provider Name (Legal Business Name): COUNTY OF RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83912 AVENUE 45
INDIO CA
92201-7351
US

IV. Provider business mailing address

4095 COUNTY CIRCLE DR
RIVERSIDE CA
92503-3410
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8455
  • Fax:
Mailing address:
  • Phone: 951-358-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LYNN CRUIKSHANK
Title or Position: CFO
Credential:
Phone: 951-486-4135