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NPI Code Detail

MEDICARE: RIVERSIDE HEALTH CARE CENTER

MEDICARE: RIVERSIDE HEALTH CARE CENTER
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
13336L0003XLong Term Care Pharmacy636MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12704496OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609931641
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVERSIDE HEALTH CARE CENTER
Provider Business Mailing Address
First Line : 1301 E BROADWAY ST
Second Line :
City : MISSOULA
State : MT
Zip : 59802-4905
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1301 E BROADWAY ST
Second Line :
City : MISSOULA
State : MT
Zip : 59802-4905
Country : US
Telephone Number : 406-721-0680
Fax Number : 406-721-1101
Authorized Official
Title or Position : MANAGING PARTNER
Name : JOHN GOODMAN
Credential : CPA
Telephone Number : 952-361-8000
Provider Enumeration Date : 12/27/2006
Last Update Date : 08/22/2020

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Directions to “RIVERSIDE HEALTH CARE CENTER ” Practice Location

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