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General NPI Number Information
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NPI Number | 1881184190
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Entity Type | Organization
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Legal Business Name | RIVERSIDE HEALING CENTER
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Dates
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Enumeration Date | 05/11/2018
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Last Update Date | 05/11/2018
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Provider Practice Location Address
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Address Line | 92 COMMERCIAL ST
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City | BATH
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State | ME
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Zip | 04530-2582
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Country | US
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Telephone | 207-389-4372
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Fax | 888-975-8208
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Provider Business Mailing Address
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Address Line | 92 COMMERCIAL ST
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City | BATH
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State | ME
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Zip | 04530-2582
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Country | US
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Telephone | 207-389-4372
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Fax | 888-975-8208
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Authorized Official
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Title or Position | DOCTOR/ OWNER
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Name | DR. CARRIE WERNER
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Credential | ND
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Telephone | 207-389-4372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | NP499
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License Number State | ME
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