Provider Demographics
NPI:1083785935
Name:RIVERSTREET HEALTHCARE
Entity Type:Organization
Organization Name:RIVERSTREET HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-226-5054
Mailing Address - Street 1:611 E HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29624-2814
Mailing Address - Country:US
Mailing Address - Phone:864-226-5054
Mailing Address - Fax:864-226-5643
Practice Address - Street 1:611 E HAMPTON ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29624-2814
Practice Address - Country:US
Practice Address - Phone:864-226-5054
Practice Address - Fax:864-226-5643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0386640001332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0386640001Medicare ID - Type UnspecifiedPROVIDER NUMBER