Healthcare Provider Details

I. General information

NPI: 1518356708
Provider Name (Legal Business Name): RIVERSIDE RECOVERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W HIGH ST STE B
MOUNT VERNON OH
43050-2427
US

IV. Provider business mailing address

PO BOX 1057
MOUNT VERNON OH
43050-8057
US

V. Phone/Fax

Practice location:
  • Phone: 740-326-9255
  • Fax:
Mailing address:
  • Phone: 740-326-1382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. AMY SMART
Title or Position: OWNER
Credential:
Phone: 740-237-9649