MEDICARE: RIVERSIDE CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	214720	PA
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	487031	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144254392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE CARE, INC

Provider Business Mailing Address
First Line	:	499 N. 5TH ST.
Second Line	:	STE A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123
Country	:	US
Telephone Number	:	215-451-7000
Fax Number	:	215-925-6897

Provider Business Practice Location Address
First Line	:	44 E. BROAD ST
Second Line	:	SUITE 020
City	:	BETHLEHEM
State	:	PA
Zip	:	18018-5920
Country	:	US
Telephone Number	:	610-868-0435
Fax Number	:	610-868-5552

Authorized Official
Title or Position	:	CFO
Name	:	MR. JONATHAN P. SOLOMONS
Credential	:
Telephone Number	:	215-451-7000

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	11/02/2010

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