Basic Information
| Provider Information | |||||||||
| NPI: | 1366501603 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVERWOOD MENTAL HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 RAILROAD AVE | ||||||||
| Address2: | PO BOX 226 | ||||||||
| City: | WARREN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028853206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012474278 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 RAILROAD AVE | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028853206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012474278 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KUBAS-MEYER | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4012474278 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320600000X | L-9010 | RI | Y | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | RR02205 | 05 | RI | MEDICAID | RR02204 | 05 | RI | MEDICAID |