Provider Demographics
NPI:1366501603
Name:RIVERWOOD MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:RIVERWOOD MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUBAS-MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-247-4278
Mailing Address - Street 1:25 RAILROAD AVE
Mailing Address - Street 2:PO BOX 226
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-3206
Mailing Address - Country:US
Mailing Address - Phone:401-247-4278
Mailing Address - Fax:
Practice Address - Street 1:25 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-3206
Practice Address - Country:US
Practice Address - Phone:401-247-4278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIL-9010320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRR02205Medicaid
RIRR02204Medicaid