Healthcare Provider Details

I. General information

NPI: 1669304572
Provider Name (Legal Business Name): RIVERTOWN TRANSITIONAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20798 NE OAK ST
BLOUNTSTOWN FL
32424-4731
US

IV. Provider business mailing address

20798 NE OAK ST
BLOUNTSTOWN FL
32424-4731
US

V. Phone/Fax

Practice location:
  • Phone: 448-214-1008
  • Fax: 448-448-2025
Mailing address:
  • Phone: 448-214-1008
  • Fax: 448-448-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CORTINA M HENRY
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 850-766-2995