Provider Demographics
NPI:1073950630
Name:RIVERSIDE COMMUNITY CARE
Entity Type:Organization
Organization Name:RIVERSIDE COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IN HOME CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:ABABA
Authorized Official - Middle Name:RAPHAEL
Authorized Official - Last Name:ABIEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-433-0672
Mailing Address - Street 1:237 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3036
Mailing Address - Country:US
Mailing Address - Phone:781-433-0672
Mailing Address - Fax:
Practice Address - Street 1:237 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3036
Practice Address - Country:US
Practice Address - Phone:781-433-0672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care