Provider Demographics
NPI:1982790903
Name:RIVERSPRING LICENSED HOME CARE SERVICES AGENCY INC
Entity Type:Organization
Organization Name:RIVERSPRING LICENSED HOME CARE SERVICES AGENCY INC
Other - Org Name:RIVERSPRING LICENSED HOME CARE SERVICES AGENCY, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-581-1313
Mailing Address - Street 1:94 W 225TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-7021
Mailing Address - Country:US
Mailing Address - Phone:347-842-3701
Mailing Address - Fax:
Practice Address - Street 1:94 W 225TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-7021
Practice Address - Country:US
Practice Address - Phone:347-842-3701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health