Provider Demographics
NPI:1275236374
Name:RILEY HOME GROUP SERVICES LLC
Entity Type:Organization
Organization Name:RILEY HOME GROUP SERVICES LLC
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ALTERNATE ADMIN/SUPERVISING NURSE
Authorized Official - Prefix:
Authorized Official - First Name:ADEPEJU
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ADELABU
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:832-757-7569
Mailing Address - Street 1:19527 CEDAR COVE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1573
Mailing Address - Country:US
Mailing Address - Phone:832-757-7569
Mailing Address - Fax:
Practice Address - Street 1:19527 CEDAR COVE CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1573
Practice Address - Country:US
Practice Address - Phone:832-757-7569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty