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General NPI Number Information
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NPI Number | 1780791467
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Entity Type | Organization
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Legal Business Name | RIVERSIDE COMMUNITY CARE, INC.
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 11/02/2017
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Provider Practice Location Address
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Address Line | 190 LENOX ST
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City | NORWOOD
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State | MA
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Zip | 02062-3416
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Country | US
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Telephone | 781-329-0909
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Fax | 781-329-2631
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Provider Business Mailing Address
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Address Line | 270 BRIDGE ST STE 301
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City | DEDHAM
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State | MA
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Zip | 02026-1798
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Country | US
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Telephone | 781-329-0909
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Fax | 781-329-2631
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MS. MARSHA MEDALIE
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Credential |
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Telephone | 781-320-5328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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