Healthcare Provider Details

I. General information

NPI: 1114971660
Provider Name (Legal Business Name): RIVERSIDE HEALTHCARE SYSTEM, L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 MAGNOLIA AVE
RIVERSIDE CA
92501-4135
US

IV. Provider business mailing address

4445 MAGNOLIA AVE
RIVERSIDE CA
92501-4135
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-3000
  • Fax: 909-788-3201
Mailing address:
  • Phone: 951-788-3000
  • Fax: 909-788-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY TODD LACAZE
Title or Position: CFO
Credential:
Phone: 951-788-3000