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General NPI Number Information
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NPI Number | 1679299093
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Entity Type | Organization
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Legal Business Name | RIVERSIDE FFK LLC
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 53 TREMONT ST
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-6131
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Country | US
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Telephone | 207-233-2274
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Fax |
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Provider Business Mailing Address
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Address Line | 117 SUNSET AVE APT 1
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-6156
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Country | US
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Telephone | 207-233-2274
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Fax |
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Authorized Official
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Title or Position | PARTNER 1
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Name | OLANREWAJU FASHINA
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Credential |
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Telephone | 207-233-2274
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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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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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