Organization
RIVERSIDE HEALTH CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GOODMAN CPA (MANAGING PARTNER)
(952) 361-8000
Entity
Organization
Contact information
Practice address
1301 E BROADWAY ST, MISSOULA, MT 59802-4905
(406) 721-0680
(406) 721-1101
Mailing address
1301 E BROADWAY ST, MISSOULA, MT 59802-4905
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
636
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212953
—
MT
01
—
2704496
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
12/27/2006
Last updated
08/22/2020
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