Healthcare Provider Details

I. General information

NPI: 1912734906
Provider Name (Legal Business Name): THE EMMANUEL PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3839 STRONG ST
RIVERSIDE CA
92501-1843
US

IV. Provider business mailing address

3839 STRONG ST
RIVERSIDE CA
92501-1843
US

V. Phone/Fax

Practice location:
  • Phone: 951-848-7441
  • Fax: 951-892-0249
Mailing address:
  • Phone: 951-848-7441
  • Fax: 951-892-0249

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: EXECUTIVE DIRECTOR
Credential:
Phone: 951-848-7441