Healthcare Provider Details

I. General information

NPI: 1225843113
Provider Name (Legal Business Name): RIVERSIDE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S KENNEDY DR
BRADLEY IL
60915-2682
US

IV. Provider business mailing address

350 N WALL ST
KANKAKEE IL
60901-2901
US

V. Phone/Fax

Practice location:
  • Phone: 815-935-7256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA KIM VILT
Title or Position: SENIOR VICE PRESIDENT AND CFO
Credential:
Phone: 815-935-7542