Basic Information
| Provider Information | |||||||||
| NPI: | 1861482051 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVERSIDE HOME HEALTH CARE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1077 GATEWAY LOOP | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974771114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417461020 | ||||||||
| FaxNumber: | 5417461021 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 SE G ST | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975263066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414761583 | ||||||||
| FaxNumber: | 5414766227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 02/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | STRAIT | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF REIMBURSEMENT SVCS | ||||||||
| AuthorizedOfficialTelephone: | 5412847092 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PINNACLE HEALTHCARE, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 13 1365 | OR | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 167474 | 05 | OR | MEDICAID |