Provider Demographics
NPI:1902199805
Name:RIVERSIDE COMMUNITY CARE
Entity Type:Organization
Organization Name:RIVERSIDE COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JAIL DIVERSION CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COSTIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-258-1621
Mailing Address - Street 1:34 POTTER ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4222
Mailing Address - Country:US
Mailing Address - Phone:401-258-1621
Mailing Address - Fax:
Practice Address - Street 1:34 POTTER ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4222
Practice Address - Country:US
Practice Address - Phone:401-258-1621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health