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General NPI Number Information
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NPI Number | 1639873011
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Entity Type | Organization
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Legal Business Name | DAILY LIVING SUPPORT RIVERSIDE LLC
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 6751 BROCKTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-3023
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Country | US
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Telephone | 951-369-7047
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Fax |
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Provider Business Mailing Address
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Address Line | 6751 BROCKTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-3023
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Country | US
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Telephone | 513-697-0479
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD SOUTHARD
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Credential |
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Telephone | 562-322-0432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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