Provider Demographics
NPI:1639873011
Name:DAILY LIVING SUPPORT RIVERSIDE LLC
Entity Type:Organization
Organization Name:DAILY LIVING SUPPORT RIVERSIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-322-0432
Mailing Address - Street 1:6751 BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3023
Mailing Address - Country:US
Mailing Address - Phone:513-697-0479
Mailing Address - Fax:
Practice Address - Street 1:6751 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3023
Practice Address - Country:US
Practice Address - Phone:951-369-7047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care