Provider Demographics
NPI:1821088113
Name:RIVERSIDE HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:RIVERSIDE HEALTH CARE CENTER, INC.
Other - Org Name:RIVERSIDE HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHADDERTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LNHA
Authorized Official - Phone:860-289-2791
Mailing Address - Street 1:745 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3115
Mailing Address - Country:US
Mailing Address - Phone:860-289-2791
Mailing Address - Fax:860-289-7713
Practice Address - Street 1:745 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3115
Practice Address - Country:US
Practice Address - Phone:860-289-2791
Practice Address - Fax:860-289-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1000C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0210009Medicaid
CT0210009Medicaid