Provider Demographics
NPI:1063462224
Name:RIVER PARK HEALTH CARE LLC
Entity Type:Organization
Organization Name:RIVER PARK HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GARAFOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-207-7771
Mailing Address - Street 1:1306 KATIE ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-5318
Mailing Address - Country:US
Mailing Address - Phone:615-228-3494
Mailing Address - Fax:615-228-0022
Practice Address - Street 1:1306 KATIE ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-5318
Practice Address - Country:US
Practice Address - Phone:615-228-3494
Practice Address - Fax:615-228-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000062314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7990394Medicaid
TN0445312Medicaid
TN445312Medicare ID - Type Unspecified