Provider Demographics
NPI:1902961782
Name:RIOUX, KATHLEEN HOPE
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:HOPE
Last Name:RIOUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 OLIVE HTS
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6815
Mailing Address - Country:US
Mailing Address - Phone:207-945-9391
Mailing Address - Fax:
Practice Address - Street 1:9 OLIVE HTS
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6815
Practice Address - Country:US
Practice Address - Phone:207-945-9391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME199340000Medicaid