Provider Demographics
NPI:1144254392
Name:RIVERSIDE CARE, INC
Entity type:Organization
Organization Name:RIVERSIDE CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SOLOMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-451-7000
Mailing Address - Street 1:499 N. 5TH ST.
Mailing Address - Street 2:STE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123
Mailing Address - Country:US
Mailing Address - Phone:215-451-7000
Mailing Address - Fax:215-925-6897
Practice Address - Street 1:44 E. BROAD ST
Practice Address - Street 2:SUITE 020
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5920
Practice Address - Country:US
Practice Address - Phone:610-868-0435
Practice Address - Fax:610-868-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA214720261QR0405X
PA487031261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007578550029Medicaid
PA1007578550032Medicaid