Provider Demographics
NPI:1376540278
Name:SENIOR HEALTH RIVER VALLEY LLC
Entity Type:Organization
Organization Name:SENIOR HEALTH RIVER VALLEY LLC
Other - Org Name:RIVER VALLEY HEALTH & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CARE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:940-464-7016
Mailing Address - Street 1:1907 REFINERY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-0000
Mailing Address - Country:US
Mailing Address - Phone:940-665-0386
Mailing Address - Fax:940-665-9314
Practice Address - Street 1:1907 REFINERY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-0000
Practice Address - Country:US
Practice Address - Phone:940-665-0386
Practice Address - Fax:940-665-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111939314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111939OtherLICENSE
TX4863Medicaid
TX4863Medicaid