Provider Demographics
NPI:1295105906
Name:RIVER RIDGE, LLC
Entity type:Organization
Organization Name:RIVER RIDGE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:952-564-3000
Mailing Address - Street 1:615 W TRAVELERS TRL
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2553
Mailing Address - Country:US
Mailing Address - Phone:952-894-7722
Mailing Address - Fax:
Practice Address - Street 1:4205 LANCASTER LN N STE 101
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-1702
Practice Address - Country:US
Practice Address - Phone:952-894-7722
Practice Address - Fax:952-894-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)