Provider Demographics
NPI:1942173406
Name:THE REDEEMER GROUP SPC THE REDEEMER
Entity type:Organization
Organization Name:THE REDEEMER GROUP SPC THE REDEEMER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEAMAMA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:909-268-4181
Mailing Address - Street 1:2979 MUMFORD CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-8807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2979 MUMFORD CT
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-8807
Practice Address - Country:US
Practice Address - Phone:951-433-3863
Practice Address - Fax:951-475-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-29
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty