Healthcare Provider Details

I. General information

NPI: 1861854242
Provider Name (Legal Business Name): RIVERWOOD-LTC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BACON ST
MADISONVILLE TX
77864-2575
US

IV. Provider business mailing address

10945 STATE BRIDGE RD SUITE 401-470
ALPHARETTA GA
30022-8164
US

V. Phone/Fax

Practice location:
  • Phone: 936-348-9097
  • Fax: 936-348-9212
Mailing address:
  • Phone: 678-381-2820
  • Fax: 678-381-2810

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: MR. DAREN DOUSTON
Title or Position: MEMBER.CFO
Credential:
Phone: 678-381-2810