Provider Demographics
NPI:1427552280
Name:RIVERDALE HEALTH GROUP LLC
Entity Type:Organization
Organization Name:RIVERDALE HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CARTER-ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:678-677-1758
Mailing Address - Street 1:200 W M L KING BLVD STE 1035B
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2560
Mailing Address - Country:US
Mailing Address - Phone:423-313-5338
Mailing Address - Fax:
Practice Address - Street 1:200 W M L KING BLVD
Practice Address - Street 2:1035 B
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402
Practice Address - Country:US
Practice Address - Phone:423-313-5338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health