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General NPI Number Information
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NPI Number | 1164891776
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Entity Type | Organization
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Legal Business Name | RIVER RIDGE, LLC
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Dates
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Enumeration Date | 09/24/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 14750 LAC LAVON DR
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City | BURNSVILLE
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State | MN
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Zip | 55306-6398
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Country | US
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Telephone | 952-894-7722
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Fax |
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Provider Business Mailing Address
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Address Line | 151 W BURNSVILLE PKWY SUITE 103
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City | BURNSVILLE
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State | MN
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Zip | 55337-2524
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Country | US
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Telephone | 952-894-7722
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRIAN P SAMMON
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Credential | MA, LMFT, LADC
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Telephone | 952-564-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | MN
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