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General NPI Number Information
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NPI Number | 1003302092
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Entity Type | Organization
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Legal Business Name | RIVERGLEN HOUSE ESL
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 55 RIVERGLEN LN
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City | LITTLETON
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State | NH
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Zip | 03561-5735
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Country | US
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Telephone | 603-991-7307
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Fax |
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Provider Business Mailing Address
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Address Line | 55 RIVERGLEN LN
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City | LITTLETON
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State | NH
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Zip | 03561-5735
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Country | US
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Telephone | 603-991-7307
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/ADMINISTRATOR
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Name | MS. GEORGENE NOVAK
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Credential |
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Telephone | 603-991-7307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 04272
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License Number State | NH
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