Healthcare Provider Details

I. General information

NPI: 1538254701
Provider Name (Legal Business Name): RIVERSIDE SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 E DEER PARK MILAN RD
CHATTAROY WA
99003-9733
US

IV. Provider business mailing address

3802 E DEER PARK MILAN RD
CHATTAROY WA
99003-9733
US

V. Phone/Fax

Practice location:
  • Phone: 509-464-8361
  • Fax: 509-464-8365
Mailing address:
  • Phone: 509-464-8361
  • Fax: 509-464-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateWA

VIII. Authorized Official

Name: MS. LYNN ROWSE
Title or Position: SPECIAL SERVICES DIRECTOR
Credential:
Phone: 509-464-8361