Healthcare Provider Details

I. General information

NPI: 1033471917
Provider Name (Legal Business Name): RIVERWOOD MENTAL HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 RAILROAD AVE
WARREN RI
02885-3206
US

IV. Provider business mailing address

25 RAILROAD AVE
WARREN RI
02885-3206
US

V. Phone/Fax

Practice location:
  • Phone: 401-247-4278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberRN45198
License Number StateRI

VIII. Authorized Official

Name: DANIEL KUBAS-MEYER
Title or Position: CEO
Credential:
Phone: 401-247-4278