MEDICARE: COUNTY OF RIVERSIDE-COMMUNITY HEALTH AGENCY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN561724	CA
2	261QF0400X	Federally Qualified Health Center (FQHC)		CA

General Provider Information

NPI Number	:	1598756926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF RIVERSIDE-COMMUNITY HEALTH AGENCY

Provider Business Mailing Address
First Line	:	PO BOX 7849
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92513-7849
Country	:	US
Telephone Number	:	951-358-5222
Fax Number	:	951-358-5235

Provider Business Practice Location Address
First Line	:	237 N D ST
Second Line	:
City	:	PERRIS
State	:	CA
Zip	:	92570-1919
Country	:	US
Telephone Number	:	951-940-6700
Fax Number	:	951-940-6726

Authorized Official
Title or Position	:	DEPUTY DIRECTOR
Name	:	MR. MICHAEL TWEEDELL
Credential	:	M.P.H
Telephone Number	:	951-358-5222

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	09/11/2025

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