MEDICARE: RIVERWOOD ALF OPERATING LLC

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
1	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275179004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERWOOD ALF OPERATING LLC

Provider Business Mailing Address
First Line	:	6873 SW US HIGHWAY 27
Second Line	:
City	:	FORT WHITE
State	:	FL
Zip	:	32038-3539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6873 SW US HIGHWAY 27
Second Line	:
City	:	FORT WHITE
State	:	FL
Zip	:	32038-3539
Country	:	US
Telephone Number	:	386-497-2273
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEVEN SCHROEDER
Credential	:
Telephone Number	:	850-647-4000

Provider Enumeration Date	:	11/27/2019
Last Update Date	:	03/30/2020

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