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General NPI Number Information
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NPI Number | 1396510988
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Entity Type | Organization
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Legal Business Name | RIVERSIDE OPERATOR LLC
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Dates
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Enumeration Date | 11/24/2023
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 1750 STOCKTON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4664
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Country | US
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Telephone | 904-308-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 STOCKTON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4664
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Country | US
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Telephone | 904-308-4700
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Fax |
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Authorized Official
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Title or Position | MEDICARE ADMINISTRATION OFFICER
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Name | MINDEE POSEN
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Credential |
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Telephone | 845-825-2217
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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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