MEDICARE: RIVERSIDE RECOVERY OF TAMPA, LLC

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1619415197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE RECOVERY OF TAMPA, LLC

Provider Business Mailing Address
First Line	:	4004 N. RIVERSIDE DR.
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603
Country	:	US
Telephone Number	:	813-296-8308
Fax Number	:	813-433-5222

Provider Business Practice Location Address
First Line	:	4004 N. RIVERSIDE DR.
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603
Country	:	US
Telephone Number	:	813-296-8308
Fax Number	:	813-433-5222

Authorized Official
Title or Position	:	VP
Name	:	SAMANTHA ALLBERRY
Credential	:
Telephone Number	:	813-575-4141

Provider Enumeration Date	:	02/06/2017
Last Update Date	:	03/19/2026

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