Provider Demographics
NPI:1225006380
Name:THE RIVERSIDE COMMUNITY CENTER, INC
Entity Type:Organization
Organization Name:THE RIVERSIDE COMMUNITY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED/CADC
Authorized Official - Phone:207-794-2150
Mailing Address - Street 1:43 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-1451
Mailing Address - Country:US
Mailing Address - Phone:207-794-2150
Mailing Address - Fax:207-794-6280
Practice Address - Street 1:43 FLEMING ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-1451
Practice Address - Country:US
Practice Address - Phone:207-794-6280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME266141101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME125240000Medicaid