Provider Demographics
NPI:1598000408
Name:RIVERDALE HOME CARE
Entity Type:Organization
Organization Name:RIVERDALE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-549-3300
Mailing Address - Street 1:6355 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2701
Mailing Address - Country:US
Mailing Address - Phone:718-549-3300
Mailing Address - Fax:718-601-0593
Practice Address - Street 1:6355 BROADWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2701
Practice Address - Country:US
Practice Address - Phone:718-549-3300
Practice Address - Fax:718-601-0593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9972L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health