| Organization Name: | RIVERSIDE RECOVERY |
| NPI Number: | 1861683724 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DANA BOYD (BUSINESS OFFICE MANAGER) |
| Mailing Address: | 155 Main Street Orofino |
| State: | ID US |
| Postal Code: | 835442287 |
| Phone Number: | 2084769393 |
| Fax Number: | 2084767932 |
| NPI Enumeration Date: | 08/06/2007 |
| NPI Last Update Date: | 08/06/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 138 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |