Provider Demographics
NPI:1104211267
Name:RIVER'S EDGE HOMECARE, LLC.
Entity Type:Organization
Organization Name:RIVER'S EDGE HOMECARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-772-0900
Mailing Address - Street 1:1910 PACIFIC AVE STE 6047
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4559
Mailing Address - Country:US
Mailing Address - Phone:682-772-0900
Mailing Address - Fax:682-228-5838
Practice Address - Street 1:1910 PACIFIC AVE STE 6047
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4559
Practice Address - Country:US
Practice Address - Phone:682-772-0900
Practice Address - Fax:682-228-5838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-05
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health