Provider Demographics
NPI:1144510215
Name:RIVERBEND SERVICES, INC.
Entity type:Organization
Organization Name:RIVERBEND SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:910-618-9260
Mailing Address - Street 1:6688 NC HIGHWAY 41 N
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2501
Mailing Address - Country:US
Mailing Address - Phone:910-618-9260
Mailing Address - Fax:910-737-6505
Practice Address - Street 1:6688 NC HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2501
Practice Address - Country:US
Practice Address - Phone:910-618-9260
Practice Address - Fax:910-737-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X, 101YP2500X, 104100000X, 1041C0700X, 106H00000X, 251B00000X, 251S00000X
NCMHL-078-166322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8703204Medicaid
NC5950227Medicaid
NC8300790Medicaid
NC6603809Medicaid
NC8702120Medicaid
NC3410202Medicaid
NC6006953Medicaid