Provider Demographics
NPI:1396275509
Name:RIVERSIDE COMMUNITY CARE
Entity type:Organization
Organization Name:RIVERSIDE COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPEUTIC MENTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESANTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-663-4658
Mailing Address - Street 1:89 PLYMOUTH DR APT 1D
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-6410
Mailing Address - Country:US
Mailing Address - Phone:413-663-4658
Mailing Address - Fax:
Practice Address - Street 1:237 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3036
Practice Address - Country:US
Practice Address - Phone:781-433-0672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health