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General NPI Number Information
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NPI Number | 1801897533
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Entity Type | Organization
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Legal Business Name | RIVERSIDE CONVALESCENT HOSPITAL, INC
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 11/20/2013
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Provider Practice Location Address
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Address Line | 1090 RIO LN
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City | SACRAMENTO
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State | CA
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Zip | 95822-1706
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Country | US
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Telephone | 916-446-2506
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Fax | 916-446-2029
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Provider Business Mailing Address
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Address Line | 1090 RIO LN
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City | SACRAMENTO
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State | CA
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Zip | 95822-1706
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Country | US
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Telephone | 916-446-2506
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Fax | 916-446-2029
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TERRY BANE
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Credential |
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Telephone | 530-897-5100
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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 | 100000082
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License Number State | CA
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