Provider Demographics
NPI:1174693899
Name:RIVERBEND SERVICES,INC
Entity type:Organization
Organization Name:RIVERBEND SERVICES,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:910-618-9260
Mailing Address - Street 1:6688 NC HIGHWAY 41 N
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2501
Mailing Address - Country:US
Mailing Address - Phone:910-618-9260
Mailing Address - Fax:919-737-6505
Practice Address - Street 1:4195 S CREEK RD
Practice Address - Street 2:
Practice Address - City:ORRUM
Practice Address - State:NC
Practice Address - Zip Code:28369-8889
Practice Address - Country:US
Practice Address - Phone:910-618-9260
Practice Address - Fax:919-737-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320900000X, 251B00000X, 251S00000X
NCMHL-078-166322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603809Medicaid
NC8300790Medicaid