NPIMap

Organization Active NPI

Riverside Medical Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kankakee, IL
National Provider Identifier
1780093708
Registry record updated Apr 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
0002014 Issued in IL
Legal business name
RIVERSIDE MEDICAL CENTER
Practice address
1905 W Court St
Kankakee, IL 60901-3163
Phone
(815) 935-7256
Fax
(815) 935-7490
NPI assigned
Aug 4, 2014
Last updated
Apr 6, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
RIVERSIDE MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 6, 2016

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 0002014 IL Primary
General Acute Care Hospital 282N00000X 0002014 IL

Addresses

Primary practice location

1905 W Court St
Kankakee, IL 60901-3163

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
Riverside Med Ctr RR13 organizations share this tax ID, including this one
Part of
Riverside Med Ctr RR

Other organizations with this tax ID 12

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

Locations

1905 W Court St
Kankakee, IL 60901
Phone (815) 933-2240

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1407110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459900800000",
    "number": "1780093708",
    "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": "1905 W COURT ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013163",
            "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": "2014-08-04",
        "last_updated": "2016-04-06",
        "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": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IL",
            "license": "0002014",
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IL",
            "license": "0002014",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 6, 2016; 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.