Healthcare Provider Details

I. General information

NPI: 1790227197
Provider Name (Legal Business Name): RIVERSTONE MANOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST
WALNUTPORT PA
18088-1023
US

IV. Provider business mailing address

1 MAIN ST POBOX 333
WALNUTPORT PA
18088-1023
US

V. Phone/Fax

Practice location:
  • Phone: 610-767-0575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ADAM HERMAN
Title or Position: OWNER
Credential:
Phone: 610-844-6693