| Riverwood Center | |
|
1485 S. M-139 Benton Harbor MI 49022 | |
| (269) 925-0585 | |
| (269) 927-1326 |
| Full Name | Riverwood Center |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1485 S. M-139, Benton Harbor, Michigan |
| Authorized Official Name and Position | Allen R Edlefson (CEO) |
| Authorized Official Contact | 2699250585 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverwood Center 1485 S. M-139 Benton Harbor MI 49022 Ph: (269) 925-0585 | Riverwood Center 1485 S. M-139 Benton Harbor MI 49022 Ph: (269) 925-0585 |
| NPI Number | 1033280763 |
|---|---|
| Provider Enumeration Date | 11/13/2006 |
| Last Update Date | 01/28/2008 |
| Medicare PECOS PAC ID | 0345223707 |
|---|---|
| Medicare Enrollment ID | O20050124000376 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033280763 | NPI | - | NPPES |
| 21-1716175 | Medicaid | MI | |
| 750910730 | Other | MI | BCBS |
| Provider Name | Matthew Lane Davis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528004744 PECOS PAC ID: 3375577836 Enrollment ID: I20050923000276 |
| Provider Name | Rebecca J Burnau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538482237 PECOS PAC ID: 3072647353 Enrollment ID: I20100823000843 |
| Provider Name | Nadine R Fish |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790097640 PECOS PAC ID: 8022299817 Enrollment ID: I20110228000345 |
| Provider Name | Lucien P Tamer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760655195 PECOS PAC ID: 8820270192 Enrollment ID: I20110308000323 |
| Provider Name | Robert E Dempsey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942271390 PECOS PAC ID: 0648356337 Enrollment ID: I20111206000748 |
| Provider Name | Dore' G Silvey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801927405 PECOS PAC ID: 2466632898 Enrollment ID: I20120809000747 |
| Provider Name | Daniel Allen Seidling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033594726 PECOS PAC ID: 5092012435 Enrollment ID: I20160329002569 |
| Provider Name | Michelle M Olson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316125065 PECOS PAC ID: 9537308846 Enrollment ID: I20160330001229 |
| Provider Name | Panankosi Mbunjwa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174949796 PECOS PAC ID: 9032409495 Enrollment ID: I20160526001466 |
| Provider Name | Keely M Adams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922548718 PECOS PAC ID: 8123303484 Enrollment ID: I20170329000390 |
| Provider Name | Darren Parker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710381090 PECOS PAC ID: 0042589962 Enrollment ID: I20170710001561 |
| Provider Name | Christina E Oldham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154833879 PECOS PAC ID: 8729345921 Enrollment ID: I20171127000085 |
| Provider Name | Faith A Shreve |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902258882 PECOS PAC ID: 7810257011 Enrollment ID: I20180208001132 |
| Provider Name | Therese A Zitta |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1073016168 PECOS PAC ID: 3274889902 Enrollment ID: I20180710002658 |
| Provider Name | Samantha J Kling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477088870 PECOS PAC ID: 5496182362 Enrollment ID: I20200305002280 |
| Provider Name | Scott R Hancock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659755957 PECOS PAC ID: 9830503556 Enrollment ID: I20210120002315 |
| Provider Name | Andrew R Mahler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891134334 PECOS PAC ID: 6800299900 Enrollment ID: I20210727003519 |
| Provider Name | Karla Marie Tennant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407522550 PECOS PAC ID: 1658778188 Enrollment ID: I20210924002416 |
| Provider Name | Heather Ann Sorensen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407312895 PECOS PAC ID: 1456743848 Enrollment ID: I20220114001112 |
| Provider Name | Hillary Anne Amador |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548719172 PECOS PAC ID: 6204210131 Enrollment ID: I20220826000747 |
| Provider Name | Yazmik S Cantillano |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649854308 PECOS PAC ID: 4183084130 Enrollment ID: I20230721002002 |
| Provider Name | Amarpreet Chela |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568957397 PECOS PAC ID: 1456713254 Enrollment ID: I20230810002122 |
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