Provider Demographics
NPI:1083102511
Name:RIVERSIDE TREATMENT SERVICES LANSDOWNE, LLC
Entity Type:Organization
Organization Name:RIVERSIDE TREATMENT SERVICES LANSDOWNE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-739-6104
Mailing Address - Street 1:8359 PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2948
Mailing Address - Country:US
Mailing Address - Phone:443-730-6104
Mailing Address - Fax:443-730-6109
Practice Address - Street 1:1903 LANSDOWNE RD
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:MD
Practice Address - Zip Code:21227-1707
Practice Address - Country:US
Practice Address - Phone:443-691-5358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone