Healthcare Provider Details

I. General information

NPI: 1477084762
Provider Name (Legal Business Name): RIVERSIDE ADULT DAY PROGRAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16935 6450 RD
MONTROSE CO
81403-7868
US

IV. Provider business mailing address

16935 6450 RD
MONTROSE CO
81403-7868
US

V. Phone/Fax

Practice location:
  • Phone: 970-249-1590
  • Fax: 970-765-2654
Mailing address:
  • Phone: 970-249-1590
  • Fax: 970-765-2654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURIE STOVER
Title or Position: OWNER
Credential:
Phone: 970-260-0067