MEDICARE: OXFORD RIVERSIDE MEMORY CARE 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	311500000X	Alzheimer Center (Dementia Center)

General Provider Information

NPI Number	:	1982357760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OXFORD RIVERSIDE MEMORY CARE LLC

Provider Business Mailing Address
First Line	:	125 N MARKET ST STE 1230
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67202-1712
Country	:	US
Telephone Number	:	316-201-3210
Fax Number	:

Provider Business Practice Location Address
First Line	:	6621 N RIVERSIDE DR
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76137-6640
Country	:	US
Telephone Number	:	817-708-2234
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	IRIS TURNER
Credential	:
Telephone Number	:	620-870-0998

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	02/03/2022

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