Healthcare Provider Details

I. General information

NPI: 1255328159
Provider Name (Legal Business Name): THE RIVERWOODS COMPANY AT EXETER, NEW HAMPSHIRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 RIVERWOODS DR RIVERWOODS AT EXETER
EXETER NH
03833-4374
US

IV. Provider business mailing address

7 RIVERWOODS DR
EXETER NH
03833-4374
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-4700
  • Fax:
Mailing address:
  • Phone: 603-742-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number140784
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number02112
License Number StateNH

VIII. Authorized Official

Name: MRS. CRYSTAL FLOYD
Title or Position: ACCOUNTING COORDINATOR
Credential:
Phone: 603-658-1580