Basic Information
| Provider Information | |||||||||
| NPI: | 1912931023 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RIVERSIDE CARE INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CONTINUUM INC D/B/A RIVERSIDE CARE INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 EAGLEVILLE ROAD | ||||||||
| Address2: | PO BOX 220 | ||||||||
| City: | EAGLEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194080220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106357445 | ||||||||
| FaxNumber: | 6106357627 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 SOUTH 10TH AVENUE | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | COATESVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103839600 | ||||||||
| FaxNumber: | 6103834811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | O'ROURKE | ||||||||
| AuthorizedOfficialFirstName: | ROSEMARY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6106357438 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 157028 | PA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 1007578550025 | 05 | PA | MEDICAID |