Provider Demographics
NPI:1831499284
Name:RIVERSIDE LONG TERM CARE INC.
Entity type:Organization
Organization Name:RIVERSIDE LONG TERM CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:207-872-7979
Mailing Address - Street 1:20 GARLAND RD
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-0600
Mailing Address - Country:US
Mailing Address - Phone:207-872-7979
Mailing Address - Fax:207-872-7922
Practice Address - Street 1:20 GARLAND RD
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:ME
Practice Address - Zip Code:04901-0600
Practice Address - Country:US
Practice Address - Phone:207-872-7979
Practice Address - Fax:207-872-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy