Healthcare Provider Details

I. General information

NPI: 1245662584
Provider Name (Legal Business Name): RIVER RUN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 WYOMING AVE
KINGSTON PA
18704-3703
US

IV. Provider business mailing address

4597 ROUTE 9 N
HOWELL NJ
07731-3382
US

V. Phone/Fax

Practice location:
  • Phone: 570-288-5496
  • Fax:
Mailing address:
  • Phone: 732-942-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: NATHAN STERN
Title or Position: AUTH. MEMBER
Credential:
Phone: 732-942-1344