Provider Demographics
NPI:1053744300
Name:RIVERVIEW ADULT DAY & HEALTH CENTER INC.
Entity type:Organization
Organization Name:RIVERVIEW ADULT DAY & HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-282-6070
Mailing Address - Street 1:18712 QUARRY ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-4527
Mailing Address - Country:US
Mailing Address - Phone:734-282-6070
Mailing Address - Fax:734-225-7355
Practice Address - Street 1:18712 QUARRY ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-4527
Practice Address - Country:US
Practice Address - Phone:734-282-6070
Practice Address - Fax:734-225-7355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI6802063993261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty