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General NPI Number Information
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NPI Number | 1609931641
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Entity Type | Organization
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Legal Business Name | RIVERSIDE HEALTH CARE CENTER
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1301 E BROADWAY ST
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City | MISSOULA
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State | MT
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Zip | 59802-4905
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Country | US
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Telephone | 406-721-0680
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Fax | 406-721-1101
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Provider Business Mailing Address
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Address Line | 1301 E BROADWAY ST
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City | MISSOULA
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State | MT
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Zip | 59802-4905
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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 | MANAGING PARTNER
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Name | JOHN GOODMAN
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Credential | CPA
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Telephone | 952-361-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 636
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License Number State | MT
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