Provider Demographics
NPI:1891323754
Name:RIVERSIDE GROUP HOME, INC.
Entity Type:Organization
Organization Name:RIVERSIDE GROUP HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELKIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-488-1419
Mailing Address - Street 1:20501 NW 33RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1345
Mailing Address - Country:US
Mailing Address - Phone:305-988-2346
Mailing Address - Fax:
Practice Address - Street 1:20501 NW 33RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-1345
Practice Address - Country:US
Practice Address - Phone:305-988-2346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities