MEDICARE: COUNTY OF RIVERSIDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	250000542	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BCP70724F	OTHER	CA	CANCER DETECTION PROGRAM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	HAP70724F	OTHER	CA	FAMILY PACT

General Provider Information

NPI Number	:	1396859179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF RIVERSIDE

Provider Business Mailing Address
First Line	:	7888 MISSION GROVE PKWY S STE 120
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-5064
Country	:	US
Telephone Number	:	951-486-6698
Fax Number	:

Provider Business Practice Location Address
First Line	:	2499 E LAKESHORE DR
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-4446
Country	:	US
Telephone Number	:	951-471-4200
Fax Number	:	951-471-4205

Authorized Official
Title or Position	:	CFO
Name	:	JENNIFER LYNN CRUIKSHANK
Credential	:
Telephone Number	:	951-486-6698

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	11/21/2025

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Directions to “COUNTY OF RIVERSIDE ” Practice Location

Language	Start Address	Practice Location

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