Riverside Service Group Inc

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

805608500 Issued in ID

Legal business name

RIVERSIDE SERVICE GROUP INC

Practice address

461 River Pkwy
Idaho Falls, ID 83402-3314

Phone

(208) 542-4517

Fax

(208) 528-9501

NPI assigned

Jan 10, 2007

Last updated

Jun 25, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Kathleen Ann Hansen

Title

President Ceo

Phone

(208) 521-6573

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277424000000",
    "number": "1346390796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3925 N AMMON RD",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834011313",
            "telephone_number": "208-521-6573",
            "fax_number": "208-528-9501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "461 RIVER PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023314",
            "telephone_number": "208-542-4517",
            "fax_number": "208-528-9501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE SERVICE GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2010-06-25",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "208-521-6573",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "ID",
            "license": "805608500",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "ID",
            "license": "807612600",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805608500",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807612600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stela Risto, LCSW
• Stephen J Ritchie, LCPC, MAC
• Rite Aid
• Noemi Rivas Briones, FNP-C
• Lorenia Rivera
• Riverstone Counseling Group
• Riverwest Dental, PLLC (RiverWest Dental)
• RM Lab LLC (Express Lab)
• Road Runner Shuttle, LLC
• Robert J Brock MD PA

• Developmentally Disabled Services Day Training Agency in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Developmentally Disabled Services Day Training Agency in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2010; 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.