Provider Demographics
NPI:1679299093
Name:RIVERSIDE FFK LLC
Entity type:Organization
Organization Name:RIVERSIDE FFK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER 1
Authorized Official - Prefix:
Authorized Official - First Name:OLANREWAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:FASHINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-233-2274
Mailing Address - Street 1:117 SUNSET AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6156
Mailing Address - Country:US
Mailing Address - Phone:207-233-2274
Mailing Address - Fax:
Practice Address - Street 1:53 TREMONT ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6131
Practice Address - Country:US
Practice Address - Phone:207-233-2274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME9385374OtherSECRETARY OF STATES