Organization
COUNTY OF RIVERSIDE
Active
Other names
LAKE ELSINORE FAMILY CARE CENTER, LAKE ELSINORE COMMUNITY HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LYNN CRUIKSHANK (CFO)
(951) 486-6698
Entity
Organization
Contact information
Practice address
2499 E LAKESHORE DR, LAKE ELSINORE, CA 92530-4446
(951) 471-4200
(951) 471-4205
Mailing address
7888 MISSION GROVE PKWY S STE 120, RIVERSIDE, CA 92508-5064
(951) 486-6698
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
250000542
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCP70724F
CANCER DETECTION PROGRAM
CA
05
—
FHC70724F
—
CA
01
—
HAP70724F
FAMILY PACT
CA
Enumeration date
08/18/2006
Last updated
11/21/2025
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