Provider Demographics
NPI:1174349906
Name:RIVERSIDE HOMECARE LLC
Entity type:Organization
Organization Name:RIVERSIDE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-212-9186
Mailing Address - Street 1:1531 RIVERSIDE AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4389
Mailing Address - Country:US
Mailing Address - Phone:254-212-9186
Mailing Address - Fax:
Practice Address - Street 1:1531 RIVERSIDE AVE UNIT B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4389
Practice Address - Country:US
Practice Address - Phone:254-212-9186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care