Provider Demographics
NPI:1083092035
Name:RIVERFRONT ACQUISITION I LLC
Entity Type:Organization
Organization Name:RIVERFRONT ACQUISITION I LLC
Other - Org Name:RESIDENCE AT BAY VUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FEMINELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-471-1022
Mailing Address - Street 1:7751 W BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2003
Mailing Address - Country:US
Mailing Address - Phone:954-473-8040
Mailing Address - Fax:
Practice Address - Street 1:105 15TH ST E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1337
Practice Address - Country:US
Practice Address - Phone:941-747-8681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011159600Medicaid