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General NPI Number Information
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NPI Number | 1417139825
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH AGENCY
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 4065 COUNTY CIRCLE DR
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City | RIVERSIDE
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State | CA
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Zip | 92503-3410
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Country | US
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Telephone | 951-358-5054
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Fax |
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Provider Business Mailing Address
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Address Line | 4065 COUNTY CIRCLE DR
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City | RIVERSIDE
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State | CA
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Zip | 92503-3410
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Country | US
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Telephone | 951-358-5054
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE ANALYST II
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Name | MS. ISABEL X MICHAELIS
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Credential |
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Telephone | 951-358-5054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 33-0407
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License Number State | CA
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