Riverside Community Supports, Inc.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

RIVERSIDE COMMUNITY SUPPORTS, INC.

Practice address

101 Mitchell St N
Ahoskie, NC 27910-3029

Phone

(252) 862-4111

Fax

(252) 862-4211

NPI assigned

Jun 10, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Antwane Heckstall, BA QP

Title

Ceo President

Phone

(252) 862-4111

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689615528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 426",
            "city": "POWELLSVILLE",
            "state": "NC",
            "postal_code": "279670426",
            "telephone_number": "252-862-4111",
            "fax_number": "252-862-4211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MITCHELL ST N",
            "city": "AHOSKIE",
            "state": "NC",
            "postal_code": "279103029",
            "telephone_number": "252-862-4111",
            "fax_number": "252-862-4211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE COMMUNITY SUPPORTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HECKSTALL",
        "authorized_official_first_name": "ANTWANE",
        "authorized_official_title_or_position": "CEO PRESIDENT",
        "authorized_official_telephone_number": "252-862-4111",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BA QP"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300813",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.