Provider Demographics
NPI:1538416128
Name:RIVERSIDE COMMUNITY CARE
Entity type:Organization
Organization Name:RIVERSIDE COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISBET
Authorized Official - Middle Name:MEGAN
Authorized Official - Last Name:KERSTING
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:508-876-8074
Mailing Address - Street 1:206 MILFORD ST
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01568-1309
Mailing Address - Country:US
Mailing Address - Phone:508-876-8074
Mailing Address - Fax:
Practice Address - Street 1:206 MILFORD ST
Practice Address - Street 2:
Practice Address - City:UPTON
Practice Address - State:MA
Practice Address - Zip Code:01568-1309
Practice Address - Country:US
Practice Address - Phone:508-876-8074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization