Organization
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Provider details
NPI number
Authorized official
MS. ERNESTINE CLAIRESA GRISSOM (FOUNDER & CEO OR EXECUTIVE DIRECTOR)
(951) 470-7802
Entity
Organization
Contact information
Practice address
8546 GLENCOE DR, RIVERSIDE, CA 92504-2316
(951) 470-7802
Mailing address
8546 GLENCOE DR, RIVERSIDE, CA 92504-2316
(951) 470-7802
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
251300000X
Local Education Agency (LEA)
—
—
251B00000X
Case Management Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
251V00000X
Voluntary or Charitable Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
10/22/2025
Last updated
10/22/2025
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