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General NPI Number Information
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NPI Number | 1700365087
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Entity Type | Organization
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Legal Business Name | RIVERS EDGE BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 04/17/2020
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Provider Practice Location Address
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Address Line | 2690 N 17TH ST
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City | COOS BAY
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State | OR
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Zip | 97420
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Country | US
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Telephone | 541-269-5333
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Fax | 541-269-5609
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Provider Business Mailing Address
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Address Line | 2690 N 17TH ST
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City | COOS BAY
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State | OR
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Zip | 97420-2134
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Country | US
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Telephone | 541-269-5333
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Fax | 541-269-5609
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT WILLIAM GERBER
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Credential | MD
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Telephone | 541-269-5333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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