Healthcare Provider Details

I. General information

NPI: 1942201181
Provider Name (Legal Business Name): RIVERCREST HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 TIME SQ
SALISBURY MD
21801-2808
US

IV. Provider business mailing address

105 TIME SQ
SALISBURY MD
21801-2808
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-2474
  • Fax: 410-749-5194
Mailing address:
  • Phone: 410-749-2474
  • Fax: 410-749-5194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number22008
License Number StateMD

VIII. Authorized Official

Name: MR. STEVEN ALLEN
Title or Position: OWNER
Credential:
Phone: 410-625-1502