Provider Demographics
NPI:1366145906
Name:RIVERSIDE AGENCIES LLC
Entity type:Organization
Organization Name:RIVERSIDE AGENCIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:FOLUSO
Authorized Official - Middle Name:O
Authorized Official - Last Name:OBAFEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-404-4184
Mailing Address - Street 1:323 MONTANA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4473
Mailing Address - Country:US
Mailing Address - Phone:718-404-4184
Mailing Address - Fax:
Practice Address - Street 1:323 MONTANA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4473
Practice Address - Country:US
Practice Address - Phone:718-404-4184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health