Provider Demographics
NPI:1861482051
Name:RIVERSIDE HOME HEALTH CARE, INC
Entity Type:Organization
Organization Name:RIVERSIDE HOME HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REIMBURSEMENT SVCS
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-284-7092
Mailing Address - Street 1:1077 GATEWAY LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1114
Mailing Address - Country:US
Mailing Address - Phone:541-746-1020
Mailing Address - Fax:541-746-1021
Practice Address - Street 1:402 SE G ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-3066
Practice Address - Country:US
Practice Address - Phone:541-476-1583
Practice Address - Fax:541-476-6227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-27
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13 1365251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR167474Medicaid
OR167474Medicaid