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General NPI Number Information
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NPI Number | 1184959017
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Entity Type | Organization
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Legal Business Name | RIVERS ADULT HOME
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 10/09/2009
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Provider Practice Location Address
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Address Line | 1797 ANDERSON HWY
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City | POWHATAN
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State | VA
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Zip | 23139-8011
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Country | US
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Telephone | 804-379-9259
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Fax | 804-639-9643
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Provider Business Mailing Address
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Address Line | 12630 THIRD BRANCH CT
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City | CHESTERFIELD
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State | VA
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Zip | 23832-3780
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Country | US
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Telephone | 804-639-0056
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Fax | 804-639-9643
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Authorized Official
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Title or Position | OWNER/EXECUTIVE DIRECTOR
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Name | CHRISTINA RIVERS REBECCA
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Credential |
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Telephone | 804-379-9252
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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 | CLO091103940
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License Number State | VA
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