MEDICARE: RIVERSIDE BEHAVIORAL HEALTH LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1871435719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	3220 VETERANS DR
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-3128
Country	:	US
Telephone Number	:	320-420-1356
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 VETERANS DR
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-3128
Country	:	US
Telephone Number	:	320-420-1356
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ASHLEY LYNN ANDERSON
Credential	:	LICSW
Telephone Number	:	320-420-1356

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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