| NPI | 1669942298 |
|---|---|
| Doing Business As | RIVERSIDE CUSTOMIZED LIVING |
| Entity Type | Organization |
| Authorized Contact | TYLER MCGLYNN President 218-280-1609 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2018-11-27 |