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1744 University Ave Riverside CA 92507-5364 | |
| (951) 224-8220 | |
| (951) 224-8230 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1744 University Ave, Riverside, California |
| Authorized Official Name and Position | Jack E Johns (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9515712300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
22675 Alessandro Blvd Moreno Valley CA 92553-8551 Ph: (951) 571-2300 | 1744 University Ave Riverside CA 92507-5364 Ph: (951) 224-8220 |
| NPI Number | 1669524534 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 09/02/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669524534 | NPI | - | NPPES |
| 1669524534 | Medicaid | CA | |
| EAP70324F | Medicaid | CA |
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