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General NPI Number Information
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NPI Number | 1225843113
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Entity Type | Organization
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Legal Business Name | RIVERSIDE MEDICAL CENTER
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 400 S KENNEDY DR
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City | BRADLEY
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State | IL
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Zip | 60915-2682
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Country | US
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Telephone | 815-935-7256
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Fax |
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Provider Business Mailing Address
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Address Line | 350 N WALL ST
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City | KANKAKEE
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State | IL
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Zip | 60901-2901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT AND CFO
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Name | PATRICIA KIM VILT
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Credential |
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Telephone | 815-935-7542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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