Healthcare Provider Details

I. General information

NPI: 1407210644
Provider Name (Legal Business Name): RIVERSIDE VILLAGE HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 ELLA LN
ALEXANDER NC
28701-5514
US

IV. Provider business mailing address

PO BOX 55
FLETCHER NC
28732-0055
US

V. Phone/Fax

Practice location:
  • Phone: 910-417-7351
  • Fax:
Mailing address:
  • Phone: 910-417-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberFCL-011
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JESSICA CLARKE
Title or Position: OWNER
Credential:
Phone: 910-417-7351