Healthcare Provider Details

I. General information

NPI: 1730146929
Provider Name (Legal Business Name): RIDERWOOD VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 GRACEFIELD ROAD ATTN: RG ADMINISTRATOR
SILVER SPRING MD
20904-0842
US

IV. Provider business mailing address

3140 GRACEFIELD ROAD ATTN: EXECUTIVE DIRECTOR
SILVER SPRING MD
20904-1820
US

V. Phone/Fax

Practice location:
  • Phone: 301-572-1300
  • Fax: 410-204-7237
Mailing address:
  • Phone: 301-572-1300
  • Fax: 410-204-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number16-040
License Number StateMD

VIII. Authorized Official

Name: JAMES K WALTER
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 410-402-2315