Healthcare Provider Details

I. General information

NPI: 1194741678
Provider Name (Legal Business Name): RIVERSIDE LIVING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BENTZ RD
PIEDMONT SC
29673-1412
US

IV. Provider business mailing address

101 GRACE DR
EASLEY SC
29640-9088
US

V. Phone/Fax

Practice location:
  • Phone: 864-845-5177
  • Fax: 864-845-5258
Mailing address:
  • Phone: 864-269-3725
  • Fax: 864-295-3383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCF-607
License Number StateSC

VIII. Authorized Official

Name: MR. JOHN F. SWIFT
Title or Position: VP & CFO
Credential:
Phone: 864-269-3725