Healthcare Provider Details

I. General information

NPI: 1225815459
Provider Name (Legal Business Name): RIVERSTONE FAMILY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 N LEVISA RD
MOUTHCARD KY
41548-8117
US

IV. Provider business mailing address

258 N LEVISA RD
MOUTHCARD KY
41548-8117
US

V. Phone/Fax

Practice location:
  • Phone: 606-835-2305
  • Fax: 606-835-2651
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALLISON NICOLE BREWER
Title or Position: APRN/OWNER
Credential: APRN
Phone: 606-434-6147