Provider Demographics
NPI:1225815459
Name:RIVERSTONE FAMILY CARE, LLC
Entity Type:Organization
Organization Name:RIVERSTONE FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-434-6147
Mailing Address - Street 1:258 N LEVISA RD
Mailing Address - Street 2:
Mailing Address - City:MOUTHCARD
Mailing Address - State:KY
Mailing Address - Zip Code:41548-8117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:258 N LEVISA RD
Practice Address - Street 2:
Practice Address - City:MOUTHCARD
Practice Address - State:KY
Practice Address - Zip Code:41548-8117
Practice Address - Country:US
Practice Address - Phone:606-835-2305
Practice Address - Fax:606-835-2651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center