Riverside Community Services

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

RIVERSIDE COMMUNITY SERVICES

Practice address

15 Cheryl Dee Ave
Lisbon, ME 04250-6056

Phone

(207) 409-2638

NPI assigned

Aug 28, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Raphael Kabata Ngaykala

Title

Ceo

Phone

(207) 409-2638

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1164207239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 CHERYL DEE AVE",
            "city": "LISBON",
            "state": "ME",
            "postal_code": "042506056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 CHERYL DEE AVE",
            "city": "LISBON",
            "state": "ME",
            "postal_code": "042506056",
            "telephone_number": "207-409-2638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE COMMUNITY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-28",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "KABATA NGAYKALA",
        "authorized_official_first_name": "RAPHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-409-2638"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Marie Penka Corriveau, CPM, IBCLC
• Katelyn Peschier, LADC, MHRT/C-P
• Lisa E Polakowski, LMSW-CC
• Pamela Pariser Rasmussen
• Justin William Richards, PHARM D
• Susan Lee Roman, LCPC
• St Samuel Mobility LLC
• Janet Stenberg
• The Lamp Alzheimer'S Residential Care Facility
• Brenda M. Thompson, LCPC

• All providers in Lisbon, ME
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.