=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871481028
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVERS EDGE SENIOR LIVING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2025
-----------------------------------------------------
Last Update Date | 07/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 S COMMERCIAL ST
-----------------------------------------------------
City | OSWEGO
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67356-9013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-281-7040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 313 S MARKET ST
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67202-3805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-265-9441
-----------------------------------------------------
Fax | 316-265-6066
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | GAYNELLE SPRINGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 316-219-1740
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------