Provider Demographics
NPI:1114971660
Name:RIVERSIDE HEALTHCARE SYSTEM, L.P.
Entity Type:Organization
Organization Name:RIVERSIDE HEALTHCARE SYSTEM, L.P.
Other - Org Name:RIVERSIDE COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:LACAZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-788-3000
Mailing Address - Street 1:4445 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4135
Mailing Address - Country:US
Mailing Address - Phone:951-788-3000
Mailing Address - Fax:909-788-3201
Practice Address - Street 1:4445 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4135
Practice Address - Country:US
Practice Address - Phone:951-788-3000
Practice Address - Fax:909-788-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ923856Medicaid
NE10025186300Medicaid
CAZZZA3301ZOtherBLUE SHIELD
ID003498300Medicaid
CA050022OtherBLUE CROSS
WA3021292Medicaid
TN12614Medicaid
CAHSC30022GMedicaid
CAHSC30022GMedicaid
CA=========925010009OtherTRICARE