Healthcare Provider Details

I. General information

NPI: 1023892924
Provider Name (Legal Business Name): TPD RIVERVIEW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 CLINTON DR
JUNEAU AK
99801-7106
US

IV. Provider business mailing address

3041 CLINTON DR
JUNEAU AK
99801-7106
US

V. Phone/Fax

Practice location:
  • Phone: 907-723-2282
  • Fax:
Mailing address:
  • Phone: 907-723-2282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: TREVOR OGDEN
Title or Position: DIRECTOR OF RISK MANAGEMENT
Credential:
Phone: 530-356-8699