MEDICARE: RIVERBEND SERVICES,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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2	251B00000X	Case Management Agency
3	251S00000X	Community/Behavioral Health Agency
4	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	MHL-078-166	NC

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	:	1174693899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERBEND SERVICES,INC

Provider Business Mailing Address
First Line	:	6688 NC HIGHWAY 41 N
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-2501
Country	:	US
Telephone Number	:	910-618-9260
Fax Number	:	919-737-6505

Provider Business Practice Location Address
First Line	:	4195 S CREEK RD
Second Line	:
City	:	ORRUM
State	:	NC
Zip	:	28369-8889
Country	:	US
Telephone Number	:	910-618-9260
Fax Number	:	919-737-6505

Authorized Official
Title or Position	:	CEO
Name	:	MS. ANGIE ROUSE
Credential	:	BS
Telephone Number	:	910-618-9260

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	06/24/2013

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Directions to “RIVERBEND SERVICES,INC ” Practice Location

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