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General NPI Number Information
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NPI Number | 1639473036
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Entity Type | Organization
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Legal Business Name | RIVERSIDE COMMUNITY CARE
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Dates
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Enumeration Date | 12/29/2010
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Last Update Date | 12/29/2010
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Provider Practice Location Address
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Address Line | 15 BEACON AVE
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City | NORWOOD
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State | MA
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Zip | 02062-2018
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Country | US
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Telephone | 781-234-8212
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Fax |
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Provider Business Mailing Address
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Address Line | 15 BEACON AVE
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City | NORWOOD
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State | MA
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Zip | 02062-2018
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Country | US
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Telephone | 781-234-8212
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | SHANNON M ADAMS
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Credential |
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Telephone | 508-809-0545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number | LN87437
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License Number State | MA
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