Healthcare Provider Details

I. General information

NPI: 1396676854
Provider Name (Legal Business Name): XILUO RIVER HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 KIRBY GATE BLVD
MEMPHIS TN
38119-2673
US

IV. Provider business mailing address

6500 KIRBY GATE BLVD
MEMPHIS TN
38119-2673
US

V. Phone/Fax

Practice location:
  • Phone: 901-752-0772
  • Fax: 901-969-4991
Mailing address:
  • Phone: 901-752-0772
  • Fax: 901-969-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WESTON HOLT
Title or Position: LLC MANAGER
Credential:
Phone: 858-798-5700