Provider Demographics
NPI:1265496244
Name:RIVERSIDE HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:RIVERSIDE HEALTH CARE CORPORATION
Other - Org Name:RIVERSIDE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-897-5100
Mailing Address - Street 1:1469 HUMBOLDT RD
Mailing Address - Street 2:SUITE #175
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1469 HUMBOLDT RD
Practice Address - Street 2:SUITE #175
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-9116
Practice Address - Country:US
Practice Address - Phone:530-897-5100
Practice Address - Fax:530-897-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-9062Medicare ID - Type Unspecified