Provider Demographics
NPI:1134692270
Name:RIVERSIDE HEALTHCARE CENTER LLC
Entity Type:Organization
Organization Name:RIVERSIDE HEALTHCARE CENTER LLC
Other - Org Name:RIVERSIDE HEALTHCARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-593-1990
Mailing Address - Street 1:30700 TELEGRAPH RD STE 2504
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4571
Mailing Address - Country:US
Mailing Address - Phone:248-593-1990
Mailing Address - Fax:248-593-9120
Practice Address - Street 1:1149 W MONROE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MI
Practice Address - Zip Code:48880-9736
Practice Address - Country:US
Practice Address - Phone:989-681-3852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility