Provider Demographics
NPI:1376801043
Name:RIVERSIDE COMMUNITY CARE
Entity Type:Organization
Organization Name:RIVERSIDE COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMERGENCY SERVICE CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:KATYA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIVACEK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:774-291-6653
Mailing Address - Street 1:32 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1748
Practice Address - Country:US
Practice Address - Phone:508-634-3420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS69008085251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health