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Organization
RIVERSIDE COMMUNITY SERVICES
Active
Organization
RIVERSIDE COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAPHAEL KABATA NGAYKALA (CEO)
(207) 409-2638
Entity
Organization
Contact information
Practice address
15 CHERYL DEE AVE, LISBON, ME 04250-6056
(207) 409-2638
Mailing address
15 CHERYL DEE AVE, LISBON, ME 04250-6056
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
08/28/2023
Last updated
08/28/2023
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