Provider Demographics
NPI:1508312216
Name:RIVERSIDE CARE OF FLORIDA, LLC
Entity Type:Organization
Organization Name:RIVERSIDE CARE OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, OCN, CMSRN
Authorized Official - Phone:813-707-0400
Mailing Address - Street 1:210 S. PARSONS AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-707-0400
Mailing Address - Fax:813-322-2362
Practice Address - Street 1:210 S. PARSONS AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-707-0400
Practice Address - Fax:813-322-2362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X
FL234041253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care