Basic Information
| Provider Information | |||||||||
| NPI: | 1497944623 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVERBEND COMMUNITY MENTAL HEALTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2032 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033022032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032267505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3 NORTH STATE STREET | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032267505 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2007 | ||||||||
| LastUpdateDate: | 01/31/2020 | ||||||||
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| AuthorizedOfficialLastName: | CORWIN | ||||||||
| AuthorizedOfficialFirstName: | JAIME | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP-HR | ||||||||
| AuthorizedOfficialTelephone: | 6032267505 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 41263521 | 05 | NH | MEDICAID |