Healthcare Provider Details

I. General information

NPI: 1174693899
Provider Name (Legal Business Name): RIVERBEND SERVICES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4195 S CREEK RD
ORRUM NC
28369-8889
US

IV. Provider business mailing address

6688 NC HIGHWAY 41 N
LUMBERTON NC
28358-2501
US

V. Phone/Fax

Practice location:
  • Phone: 910-618-9260
  • Fax: 919-737-6505
Mailing address:
  • Phone: 910-618-9260
  • Fax: 919-737-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-078-166
License Number StateNC

VIII. Authorized Official

Name: MS. ANGIE ROUSE
Title or Position: CEO
Credential: BS
Phone: 910-618-9260