Provider Demographics
NPI:1063821973
Name:S-H OPCO PLAZA ON THE RIVER, LLC
Entity Type:Organization
Organization Name:S-H OPCO PLAZA ON THE RIVER, LLC
Other - Org Name:JUNIPER VILLAGE AT GUADALUPE RIVERFRONT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRAGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-728-9063
Mailing Address - Street 1:808 GUADALUPE ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5099
Mailing Address - Country:US
Mailing Address - Phone:830-895-2636
Mailing Address - Fax:
Practice Address - Street 1:808 GUADALUPE ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5099
Practice Address - Country:US
Practice Address - Phone:830-895-2636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
675654Medicare Oscar/Certification