Healthcare Provider Details

I. General information

NPI: 1942750823
Provider Name (Legal Business Name): RIVERSIDE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 ARKANSAS STREET
ARKOMA OK
74901
US

IV. Provider business mailing address

PO BOX 749
WARNER OK
74469-0749
US

V. Phone/Fax

Practice location:
  • Phone: 918-875-3107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH4003-4003
License Number StateOK

VIII. Authorized Official

Name: MR. JOHN E ROGERS
Title or Position: MEMBER
Credential:
Phone: 918-404-3443