Healthcare Provider Details

I. General information

NPI: 1174743207
Provider Name (Legal Business Name): RIVERSIDE INDUSTRIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COTTAGE ST
EASTHAMPTON MA
01027-1672
US

IV. Provider business mailing address

1 COTTAGE ST
EASTHAMPTON MA
01027-1672
US

V. Phone/Fax

Practice location:
  • Phone: 413-527-2711
  • Fax: 413-529-9715
Mailing address:
  • Phone: 413-527-2711
  • Fax: 413-529-9715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9785469
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: MR. RONALD D BITTEL
Title or Position: PRESIDENT
Credential:
Phone: 413-527-2711