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NPI Code Detail

MEDICARE: RIVER WEST, L.P.

MEDICARE: RIVER WEST, L.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1275N00000XMedicare Defined Swing Bed Hospital Unit399LA

General Provider Information

NPI Number : 1194796565
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVER WEST, L.P.
Provider Business Mailing Address
First Line : 2424 50TH ST
Second Line : SUITE 303
City : LUBBOCK
State : TX
Zip : 79412-2549
Country : US
Telephone Number : 502-253-0771
Fax Number :
Provider Business Practice Location Address
First Line : 59355 RIVER WEST DR
Second Line :
City : PLAQUEMINE
State : LA
Zip : 70764-6553
Country : US
Telephone Number : 225-687-9222
Fax Number :
Authorized Official
Title or Position : SENIOR VP, LICENSURE
Name : MR. CHARLES J FULNER
Credential :
Telephone Number : 502-253-0771
Provider Enumeration Date : 02/01/2006
Last Update Date : 04/20/2008

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Directions to “RIVER WEST, L.P. ” Practice Location

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