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General NPI Number Information
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NPI Number | 1891323754
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Entity Type | Organization
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Legal Business Name | RIVERSIDE GROUP HOME, INC.
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 03/27/2020
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Provider Practice Location Address
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Address Line | 20501 NW 33RD CT
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-1345
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Country | US
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Telephone | 305-988-2346
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Fax |
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Provider Business Mailing Address
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Address Line | 20501 NW 33RD CT
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-1345
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Country | US
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Telephone | 305-988-2346
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. BELKIS ALVAREZ RUIZ
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Credential |
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Telephone | 786-488-1419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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