Provider Demographics
NPI:1598170144
Name:RIVERSIDE COMMUNITY CARE
Entity Type:Organization
Organization Name:RIVERSIDE COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAYNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:781-246-2010
Mailing Address - Street 1:338 MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-5042
Mailing Address - Country:US
Mailing Address - Phone:781-246-2010
Mailing Address - Fax:
Practice Address - Street 1:338 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-5042
Practice Address - Country:US
Practice Address - Phone:781-246-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health