Riverside Hospital Corporation

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

Legal business name

RIVERSIDE HOSPITAL CORPORATION

Practice address

533 N Niles Ave
South Bend, IN 46617-1919

Phone

(574) 283-1104

Fax

(574) 283-2178

NPI assigned

Nov 21, 2006

Organization subpart

No

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

Authorized official

Name

Brenda J Clanton

Title

Contracts Manager

Phone

(574) 283-1107

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Hospital certification: CCN 154049

Legal name

RIVERSIDE HOSPITAL CORPORATION

Certification status

Terminated Voluntary: merger or closure, Apr 6, 2011

Provider type (POS)

Hospital – Psychiatric

Participating since

Apr 20, 2000

Last certification

Aug 26, 2010

Beds

16

Ownership / control type

Private (not for profit)

Facility address

533 N Niles Ave
South Bend, IN 46617

Locations

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264982400000",
    "number": "1649345448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "533 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171919",
            "telephone_number": "574-283-1104",
            "fax_number": "574-283-2178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "533 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171919",
            "telephone_number": "574-283-1104",
            "fax_number": "574-283-2178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2010-02-01",
        "status": "A",
        "authorized_official_last_name": "CLANTON",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CONTRACTS MANAGER",
        "authorized_official_telephone_number": "574-283-1107"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200264930A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Phoebe Lynn Ritter, FNP-C
• Cassidy Marie Rivas Rodriguez, CF-SLP
• River Valley Wellness Center
• Riverbend Behavioral Health, LLC
• Riverbend Behavioral Health, LLC
• Brandi Rizer, RBT
• Syed Mohsan Rizvi, MD
• Nicholas Rizzo, M.D.
• Shannon L Roach, NP
• Road Runner Inc.

• Psychiatric Hospital in South Bend, IN
• Providers in South Bend, IN by specialty
• Psychiatric Hospital in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.