| Rivers Edge Behavioral Health Llc | |
|
2690 N 17th St Coos Bay OR 97420 | |
| (541) 269-5333 | |
| (541) 269-5609 |
| Full Name | Rivers Edge Behavioral Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2690 N 17th St, Coos Bay, Oregon |
| Authorized Official Name and Position | Robert William Gerber (OWNER) |
| Authorized Official Contact | 5412695333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rivers Edge Behavioral Health Llc 2690 N 17th St Coos Bay OR 97420-2134 Ph: (541) 269-5333 | Rivers Edge Behavioral Health Llc 2690 N 17th St Coos Bay OR 97420 Ph: (541) 269-5333 |
| NPI Number | 1700365087 |
|---|---|
| Provider Enumeration Date | 08/08/2018 |
| Last Update Date | 04/17/2020 |
| Certification Date | 04/17/2020 |
| Medicare PECOS PAC ID | 9830436062 |
|---|---|
| Medicare Enrollment ID | O20190126000005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700365087 | NPI | - | NPPES |
| 500754219 | Medicaid | OR | |
| 500754223 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Robert W Gerber |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518941350 PECOS PAC ID: 1759356413 Enrollment ID: I20040908000593 |
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