Provider Demographics
NPI:1598367419
Name:RIVERSIDE TRAINING INDUSTRIES, INC.
Entity Type:Organization
Organization Name:RIVERSIDE TRAINING INDUSTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROCIOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-335-5784
Mailing Address - Street 1:110 FOSS WAY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1430
Mailing Address - Country:US
Mailing Address - Phone:937-335-5784
Mailing Address - Fax:937-552-5512
Practice Address - Street 1:110 FOSS WAY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1430
Practice Address - Country:US
Practice Address - Phone:937-335-5784
Practice Address - Fax:937-552-5512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH103540118OtherDUNS
OH5504378OtherDODD
OH624310OtherNAICS CODE
OH0118155Medicaid