Healthcare Provider Details

I. General information

NPI: 1710692082
Provider Name (Legal Business Name): RIVERSIDE REHABILITATION AND HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W HOSPITAL ST
TAYLOR PA
18517-2012
US

IV. Provider business mailing address

575 ROUTE 70 FL 2
BRICK NJ
08723-4042
US

V. Phone/Fax

Practice location:
  • Phone: 570-562-2102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHAI BERDUGO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 570-562-2102