Provider Demographics
NPI:1881184190
Name:RIVERSIDE HEALING CENTER
Entity Type:Organization
Organization Name:RIVERSIDE HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:207-389-4372
Mailing Address - Street 1:92 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2582
Mailing Address - Country:US
Mailing Address - Phone:207-389-4372
Mailing Address - Fax:888-975-8208
Practice Address - Street 1:92 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2582
Practice Address - Country:US
Practice Address - Phone:207-389-4372
Practice Address - Fax:888-975-8208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MENP499261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty