Provider Demographics
NPI:1275237448
Name:RIVERSIDE THERAPY CENTER
Entity Type:Organization
Organization Name:RIVERSIDE THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FACCIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-686-6414
Mailing Address - Street 1:2022 N RIO GRANDE LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-9499
Mailing Address - Country:US
Mailing Address - Phone:402-686-6414
Mailing Address - Fax:
Practice Address - Street 1:2022 N RIO GRANDE LN
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99016-9499
Practice Address - Country:US
Practice Address - Phone:402-686-6414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1174155600Medicaid