Healthcare Provider Details

I. General information

NPI: 1992281372
Provider Name (Legal Business Name): RIVERSIDE COMMUNITY HEALTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 LEMON ST
RIVERSIDE CA
92501
US

IV. Provider business mailing address

4275 LEMON ST
RIVERSIDE CA
92501
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-3471
  • Fax: 951-465-7243
Mailing address:
  • Phone: 951-788-3471
  • Fax: 951-465-7243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: DANIEL ANDERSON
Title or Position: PRESIDENT /CEO
Credential: D MIN
Phone: 951-788-3471