Provider Demographics
NPI:1003227315
Name:RIVERWOOD ASSISTED LIVING FACILITY, INC
Entity Type:Organization
Organization Name:RIVERWOOD ASSISTED LIVING FACILITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ-MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-884-9462
Mailing Address - Street 1:7211 RIVERWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2001
Mailing Address - Country:US
Mailing Address - Phone:813-884-9462
Mailing Address - Fax:813-884-9490
Practice Address - Street 1:7211 RIVERWOOD BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2001
Practice Address - Country:US
Practice Address - Phone:813-884-9462
Practice Address - Fax:813-884-9490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility