Healthcare Provider Details

I. General information

NPI: 1396510988
Provider Name (Legal Business Name): RIVERSIDE OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2023
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 STOCKTON ST
JACKSONVILLE FL
32204-4664
US

IV. Provider business mailing address

1750 STOCKTON ST
JACKSONVILLE FL
32204-4664
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-4700
  • Fax:
Mailing address:
  • Phone: 904-308-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MINDEE POSEN
Title or Position: MEDICARE ADMINISTRATION OFFICER
Credential:
Phone: 845-825-2217