Provider Demographics
NPI:1033715776
Name:RIVERSIDE NATURAL IMAGE LLC
Entity Type:Organization
Organization Name:RIVERSIDE NATURAL IMAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-956-1087
Mailing Address - Street 1:1103 STEWART AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4886
Mailing Address - Country:US
Mailing Address - Phone:951-781-9327
Mailing Address - Fax:951-781-9380
Practice Address - Street 1:4148 10TH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3110
Practice Address - Country:US
Practice Address - Phone:951-781-9327
Practice Address - Fax:951-781-9380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies