Healthcare Provider Details

I. General information

NPI: 1457268427
Provider Name (Legal Business Name): PEARLS OF WISDOM GRACEFUL HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 MONROE ST
RIVERSIDE CA
92504-4271
US

IV. Provider business mailing address

2845 MONROE ST
RIVERSIDE CA
92504-4271
US

V. Phone/Fax

Practice location:
  • Phone: 951-565-9921
  • Fax: 951-565-9921
Mailing address:
  • Phone: 951-565-9921
  • Fax: 951-565-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENELL ROSS
Title or Position: MANAGING MEMBER
Credential: SUDCC IV
Phone: 951-565-9921