Healthcare Provider Details

I. General information

NPI: 1700365087
Provider Name (Legal Business Name): RIVERS EDGE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 N 17TH ST
COOS BAY OR
97420
US

IV. Provider business mailing address

2690 N 17TH ST
COOS BAY OR
97420-2134
US

V. Phone/Fax

Practice location:
  • Phone: 541-269-5333
  • Fax: 541-269-5609
Mailing address:
  • Phone: 541-269-5333
  • Fax: 541-269-5609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT WILLIAM GERBER
Title or Position: OWNER
Credential: MD
Phone: 541-269-5333