Basic Information
| Provider Information | |||||||||
| NPI: | 1154800597 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVERBEND COMMUNITY MENTAL HEALTH, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2032 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033022032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032267505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 105 LOUDON RD | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033022032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032280547 | ||||||||
| FaxNumber: | 6034154570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2018 | ||||||||
| LastUpdateDate: | 01/31/2020 | ||||||||
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| AuthorizedOfficialLastName: | CORWIN | ||||||||
| AuthorizedOfficialFirstName: | JAIME | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP-HR | ||||||||
| AuthorizedOfficialTelephone: | 6032267505 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.