Provider Demographics
NPI:1871581801
Name:RIVERWOOD CENTER, LLC
Entity type:Organization
Organization Name:RIVERWOOD CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-852-7000
Mailing Address - Street 1:2802 PARENTAL HOME RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5702
Mailing Address - Country:US
Mailing Address - Phone:904-721-0088
Mailing Address - Fax:904-724-7370
Practice Address - Street 1:2802 PARENTAL HOME RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5702
Practice Address - Country:US
Practice Address - Phone:904-721-0088
Practice Address - Fax:904-724-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1131095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC105135OtherUNITED AMERICAN
FL0004427159OtherTRICARE
FL026067300Medicaid
FLN74OtherBLUE CROSS BLUE SHIELD
FLC105135OtherUNITED AMERICAN
FL026067300Medicaid