Healthcare Provider Details

I. General information

NPI: 1164413282
Provider Name (Legal Business Name): RIVERIDGE INVESTMENTS & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 WELLS ST
NILES MI
49120-1543
US

IV. Provider business mailing address

1333 WELLS ST
NILES MI
49120-1543
US

V. Phone/Fax

Practice location:
  • Phone: 269-684-1111
  • Fax:
Mailing address:
  • Phone: 269-684-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number114050
License Number StateMI

VIII. Authorized Official

Name: MR. CRAIG D. TAYLOR
Title or Position: CHIEF MANAGER
Credential:
Phone: 423-308-1845