Provider Demographics
NPI:1912244732
Name:RIVERSIDE REHAB INC
Entity type:Organization
Organization Name:RIVERSIDE REHAB INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:HERSHEL
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CRC
Authorized Official - Phone:208-853-8536
Mailing Address - Street 1:7711 W RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-6182
Mailing Address - Country:US
Mailing Address - Phone:208-853-8536
Mailing Address - Fax:208-853-2929
Practice Address - Street 1:7711 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-6182
Practice Address - Country:US
Practice Address - Phone:208-853-8536
Practice Address - Fax:208-853-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health