MEDICARE: RIVERSIDE RIDESHARE SERVICE,LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3104A0625X	Assisted Living Facility (Mental Illness)
2	332U00000X	Home Delivered Meals
3	347C00000X	Private Vehicle
4	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1922931773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE RIDESHARE SERVICE,LLC

Provider Business Mailing Address
First Line	:	PO BOX 184
Second Line	:
City	:	RUSSELL SPRINGS
State	:	KY
Zip	:	42642-0184
Country	:	US
Telephone Number	:	859-398-1439
Fax Number	:

Provider Business Practice Location Address
First Line	:	298 CHRISTOPHER DR
Second Line	:
City	:	RUSSELL SPRINGS
State	:	KY
Zip	:	42642
Country	:	US
Telephone Number	:	859-398-1439
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	MICHAEL BURCHETT
Credential	:
Telephone Number	:	270-566-1441

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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