NPIMap

Organization Active NPI

Riverside Medical Center

  • General Acute Care Hospital
  • Kankakee, IL
National Provider Identifier
1558774869
Registry record updated Jun 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
0002014 Issued in IL
Legal business name
RIVERSIDE MEDICAL CENTER
Practice address
260 S Washington Ave
Kankakee, IL 60901-3729
Phone
(815) 935-7256
Fax
(815) 935-7490
NPI assigned
Jun 4, 2014
Organization subpart
Yes
Parent organization
RIVERSIDE MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 4, 2014

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

Authorized official

Name
Mr. Bill W Douglas
Title
Vice President and Cfo
Phone
(815) 935-7256

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 0002014 IL Primary

Addresses

Primary practice location

260 S Washington Ave
Kankakee, IL 60901-3729

Mailing address

350 N Wall St
Kankakee, IL 60901-2901
Phone (815) 935-7256

Other names 1

  • Crisis Residential Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Pembroke Clinic13 organizations share this tax ID, including this one
Part of
Pembroke Clinic

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

260 S Washington Ave
Kankakee, IL 60901

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1401840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401840000000",
    "number": "1558774869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N WALL ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012901",
            "telephone_number": "815-935-7256",
            "fax_number": "815-935-7490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 S WASHINGTON AVE",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013729",
            "telephone_number": "815-935-7256",
            "fax_number": "815-935-7490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RIVERSIDE MEDICAL CENTER",
        "enumeration_date": "2014-06-04",
        "last_updated": "2014-06-04",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "BILL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "VICE PRESIDENT AND CFO",
        "authorized_official_telephone_number": "815-935-7256",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IL",
            "license": "0002014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crisis Residential Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kankakee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2014; 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.