Provider Demographics
NPI:1568529600
Name:RIVERSIDE HOME MEDICAL SUPPLY
Entity Type:Organization
Organization Name:RIVERSIDE HOME MEDICAL SUPPLY
Other - Org Name:RIVERSIDE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-683-0018
Mailing Address - Street 1:2906 RUBIDOUX BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-2149
Mailing Address - Country:US
Mailing Address - Phone:951-683-0018
Mailing Address - Fax:951-788-6496
Practice Address - Street 1:16950 WESTVIEW AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2736
Practice Address - Country:US
Practice Address - Phone:708-596-2126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3860950001Medicare ID - Type Unspecified