Healthcare Provider Details

I. General information

NPI: 1891797874
Provider Name (Legal Business Name): RIVERWOOD NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ACME ST
JACKSONVILLE FL
32211-7953
US

IV. Provider business mailing address

40 ACME ST
JACKSONVILLE FL
32211-7953
US

V. Phone/Fax

Practice location:
  • Phone: 904-724-5933
  • Fax: 904-721-1274
Mailing address:
  • Phone: 904-724-5933
  • Fax: 904-721-1274

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: MS. MARY LU FLORY
Title or Position: VP OPERATIONS
Credential: RN NHA HR
Phone: 770-993-4000