Provider Demographics
NPI:1770517922
Name:RIVERSIDE CARE, INC
Entity type:Organization
Organization Name:RIVERSIDE CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SOLOMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-451-7000
Mailing Address - Street 1:499 N 5TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-4005
Mailing Address - Country:US
Mailing Address - Phone:215-451-7000
Mailing Address - Fax:215-925-6897
Practice Address - Street 1:5501 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3205
Practice Address - Country:US
Practice Address - Phone:215-747-6480
Practice Address - Fax:215-747-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA807359261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007578550007Medicaid
PA1007578550033Medicaid
PA1007578550027OtherMEDICAID TYPE 11