Healthcare Provider Details

I. General information

NPI: 1508312216
Provider Name (Legal Business Name): RIVERSIDE CARE OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S. PARSONS AVE SUITE 9
BRANDON FL
33511
US

IV. Provider business mailing address

210 S. PARSONS AVE SUITE 9
BRANDON FL
33511
US

V. Phone/Fax

Practice location:
  • Phone: 813-707-0400
  • Fax: 813-322-2362
Mailing address:
  • Phone: 813-707-0400
  • Fax: 813-322-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number234041
License Number StateFL

VIII. Authorized Official

Name: MS. CASSANDRA VIRGINIA SIMPSON
Title or Position: OWNER/ADMINISTRATOR
Credential: BSN, RN, OCN, CMSRN
Phone: 813-707-0400