MEDICARE: SENIOR HEALTH RIVER VALLEY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	111939	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	111939	OTHER	TX	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376540278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR HEALTH RIVER VALLEY LLC

Provider Business Mailing Address
First Line	:	1907 REFINERY RD
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-0000
Country	:	US
Telephone Number	:	940-665-0386
Fax Number	:	940-665-9314

Provider Business Practice Location Address
First Line	:	1907 REFINERY RD
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-0000
Country	:	US
Telephone Number	:	940-665-0386
Fax Number	:	940-665-9314

Authorized Official
Title or Position	:	REGIONAL CARE MANAGER
Name	:	MR. LARRY LEE SNOW
Credential	:	RN
Telephone Number	:	940-464-7016

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/03/2007

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Directions to “SENIOR HEALTH RIVER VALLEY LLC ” Practice Location

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