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General NPI Number Information
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NPI Number | 1073497541
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Entity Type | Organization
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Legal Business Name | RIVERSIDE, COUNTY OF
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 20545 HARVILL AVENUE
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City | PERRIS
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State | CA
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Zip | 92570
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Country | US
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Telephone | 951-358-5222
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Fax |
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Provider Business Mailing Address
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Address Line | 7888 MISSION GROVE PKWY S STE 120
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City | RIVERSIDE
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State | CA
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Zip | 92508-5064
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JENNIFER LYNN CRUIKSHANK
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Credential |
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Telephone | 951-486-4450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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