Provider Demographics
NPI:1235330663
Name:RIVERFRONT COUNSELING LLC
Entity Type:Organization
Organization Name:RIVERFRONT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:563-324-3200
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52805-0085
Mailing Address - Country:US
Mailing Address - Phone:563-324-3200
Mailing Address - Fax:563-324-3210
Practice Address - Street 1:102 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52801-1811
Practice Address - Country:US
Practice Address - Phone:563-324-3200
Practice Address - Fax:563-324-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0760793Medicaid
IA0743716Medicaid