Healthcare Provider Details

I. General information

NPI: 1336142314
Provider Name (Legal Business Name): RIVER WILLOWS NURSING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 MAIN ST E
ABBEVILLE GA
31001-4216
US

IV. Provider business mailing address

206 MAIN ST E
ABBEVILLE GA
31001-4216
US

V. Phone/Fax

Practice location:
  • Phone: 229-467-2515
  • Fax: 229-467-2891
Mailing address:
  • Phone: 478-374-0805
  • Fax: 478-374-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number11561796
License Number StateGA

VIII. Authorized Official

Name: MR. BEN HARVILL
Title or Position: CFO
Credential:
Phone: 478-374-0805