Healthcare Provider Details

I. General information

NPI: 1225006380
Provider Name (Legal Business Name): THE RIVERSIDE COMMUNITY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 FLEMING ST
LINCOLN ME
04457-1451
US

IV. Provider business mailing address

43 FLEMING ST
LINCOLN ME
04457-1451
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-6280
  • Fax:
Mailing address:
  • Phone: 207-794-2150
  • Fax: 207-794-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number266141
License Number StateME

VIII. Authorized Official

Name: MRS. DONNA G. COWAN
Title or Position: ADMINISTRATOR
Credential: M.ED./CADC
Phone: 207-794-2150