Healthcare Provider Details

I. General information

NPI: 1821507930
Provider Name (Legal Business Name): RIVERWOOD GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 GODLEY RD
SAINT HELENA ISLAND SC
29920-5113
US

IV. Provider business mailing address

42 GODLEY RD
SAINT HELENA ISLAND SC
29920-5113
US

V. Phone/Fax

Practice location:
  • Phone: 402-033-9143
  • Fax: 402-592-5901
Mailing address:
  • Phone: 402-033-9143
  • Fax: 402-592-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JIM WEISS
Title or Position: DIRECTOR OF QUALITY MANAGEMENT
Credential:
Phone: 402-339-1436