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General NPI Number Information
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NPI Number | 1023985561
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Entity Type | Organization
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Legal Business Name | RIVERIDGE MI OPCO LLC
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 1333 WELLS ST
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City | NILES
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State | MI
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Zip | 49120-1543
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Country | US
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Telephone | 732-330-2157
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Fax |
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Provider Business Mailing Address
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Address Line | 175 ROUTE 70 STE 207
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City | TOMS RIVER
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State | NJ
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Zip | 08755-0936
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Country | US
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Telephone | 732-330-2157
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Fax | 732-330-2157
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Authorized Official
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Title or Position | AR
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Name | ESTI PRUZANSKY
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Credential |
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Telephone | 732-330-2157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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