Healthcare Provider Details

I. General information

NPI: 1609559228
Provider Name (Legal Business Name): THE EMMANUEL PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 PALERMO DR
RIVERSIDE CA
92507-2393
US

IV. Provider business mailing address

1622 PALERMO DR
RIVERSIDE CA
92507-2393
US

V. Phone/Fax

Practice location:
  • Phone: 156-268-5461
  • Fax:
Mailing address:
  • Phone: 562-685-4610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: MR. JUAN CORNELL
Title or Position: CEO
Credential:
Phone: 562-685-4610