Organization
RIVERSIDE MEDICAL CENTER
Active
Parent organization
RIVERSIDE MEDICAL CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
RIVERSIDE MEDICAL CENTER
Authorized official
MR. BILL DOUGLAS (CFO)
(815) 935-7256
Entity
Organization
Contact information
Practice address
611 DIVISION STREET, PEOTONE, IL 60468-9590
(815) 935-3272
(815) 937-7961
Mailing address
350 N WALL ST, KANKAKEE, IL 60901-2901
(815) 933-1671
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1001668
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
216396
PERSONAL CARE
IL
01
—
50482
BLUE CROSS BLUE SHIELD
IL
01
—
MW10893
MEDICARE ELECTRONIC NUMBE
IL
Enumeration date
12/28/2006
Last updated
09/30/2019
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