Organization
RIVERSIDE FFK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLANREWAJU FASHINA (PARTNER 1)
(207) 233-2274
Entity
Organization
Contact information
Practice address
53 TREMONT ST, SOUTH PORTLAND, ME 04106-6131
(207) 233-2274
Mailing address
117 SUNSET AVE APT 1, SOUTH PORTLAND, ME 04106-6156
(207) 233-2274
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9385374
SECRETARY OF STATES
ME
Enumeration date
10/17/2022
Last updated
10/17/2022
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