| Riverside Ffk Llc | |
|
53 Tremont St South Portland ME 04106-6131 | |
| (207) 233-2274 | |
| Not Available |
| Full Name | Riverside Ffk Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 53 Tremont St, South Portland, Maine |
| Authorized Official Name and Position | Olanrewaju Fashina (PARTNER 1) |
| Authorized Official Contact | 2072332274 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverside Ffk Llc 117 Sunset Ave Apt 1 South Portland ME 04106-6156 Ph: (207) 233-2274 | Riverside Ffk Llc 53 Tremont St South Portland ME 04106-6131 Ph: (207) 233-2274 |
| NPI Number | 1679299093 |
|---|---|
| Provider Enumeration Date | 10/17/2022 |
| Last Update Date | 10/17/2022 |
| Certification Date | 10/16/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679299093 | NPI | - | NPPES |
| 9385374 | Other | ME | SECRETARY OF STATES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 253Z00000X | In Home Supportive Care | (* (Not Available)) | Secondary |
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