Provider Demographics
NPI:1871579698
Name:RIVERSIDE HEALTHCARE, L.P.
Entity type:Organization
Organization Name:RIVERSIDE HEALTHCARE, L.P.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-992-0441
Mailing Address - Street 1:5100 WEST ST NW
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2173
Mailing Address - Country:US
Mailing Address - Phone:770-787-0211
Mailing Address - Fax:770-786-2462
Practice Address - Street 1:5100 WEST ST NW
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2173
Practice Address - Country:US
Practice Address - Phone:770-787-0211
Practice Address - Fax:770-786-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-107-1372314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000140324AMedicaid
GA450427903AMedicaid
GA115375Medicare Oscar/Certification