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1780791467

NPI Code Detail

MEDICARE: RIVERSIDE COMMUNITY CARE, INC.

MEDICARE: RIVERSIDE COMMUNITY 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	251S00000X	Community/Behavioral Health Agency

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
3	EI0028	OTHER	MA	BLUECROSSBLUESHIELDMA
4	617939	OTHER	MA	HPHC
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	612780	OTHER	MA	TUFTS
8	715687	OTHER	MA	TUFTS
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	M18647	OTHER	MA	BLUECROSSBLUESHIELD MA
11	0007559	OTHER	MA	NHP EI
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	42285	OTHER	MA	MAGELLAN
15	1004385	OTHER	MA	BEACON -FALLON & NHP
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780791467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE COMMUNITY CARE, INC.

Provider Business Mailing Address
First Line	:	270 BRIDGE ST STE 301
Second Line	:
City	:	DEDHAM
State	:	MA
Zip	:	02026-1798
Country	:	US
Telephone Number	:	781-329-0909
Fax Number	:	781-329-2631

Provider Business Practice Location Address
First Line	:	190 LENOX ST
Second Line	:
City	:	NORWOOD
State	:	MA
Zip	:	02062-3416
Country	:	US
Telephone Number	:	781-329-0909
Fax Number	:	781-329-2631

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	MS. MARSHA MEDALIE
Credential	:
Telephone Number	:	781-320-5328

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	11/02/2017

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1336224955 — MS. JILL H. NAGORNIAK LICSW
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Directions to “RIVERSIDE COMMUNITY CARE, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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