Provider Demographics
NPI:1003302092
Name:RIVERGLEN HOUSE ESL
Entity Type:Organization
Organization Name:RIVERGLEN HOUSE ESL
Other - Org Name:RIVERGLEN HOUSE OF LITTLETON
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GEORGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-991-7307
Mailing Address - Street 1:55 RIVERGLEN LN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-5735
Mailing Address - Country:US
Mailing Address - Phone:603-991-7307
Mailing Address - Fax:
Practice Address - Street 1:55 RIVERGLEN LN
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-5735
Practice Address - Country:US
Practice Address - Phone:603-991-7307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04272310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility