Provider Demographics
NPI:1477084762
Name:RIVERSIDE ADULT DAY PROGRAM, LLC
Entity Type:Organization
Organization Name:RIVERSIDE ADULT DAY PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-260-0067
Mailing Address - Street 1:16935 6450 RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81403-7868
Mailing Address - Country:US
Mailing Address - Phone:970-249-1590
Mailing Address - Fax:970-765-2654
Practice Address - Street 1:16935 6450 RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81403-7868
Practice Address - Country:US
Practice Address - Phone:970-249-1590
Practice Address - Fax:970-765-2654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care