Provider Demographics
NPI:1164087060
Name:RIVERSIDE HOSPICE CARE
Entity Type:Organization
Organization Name:RIVERSIDE HOSPICE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO,CFO, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NERSESYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-284-9698
Mailing Address - Street 1:9261 FOLSOM BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2559
Mailing Address - Country:US
Mailing Address - Phone:916-668-8866
Mailing Address - Fax:
Practice Address - Street 1:9261 FOLSOM BLVD STE 402
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2559
Practice Address - Country:US
Practice Address - Phone:916-668-8866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based