Provider Demographics
NPI:1508390725
Name:RILEY-MACK, INC.
Entity Type:Organization
Organization Name:RILEY-MACK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/RCFE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUEBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-529-0185
Mailing Address - Street 1:7223 OVAR CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3460
Mailing Address - Country:US
Mailing Address - Phone:916-647-3335
Mailing Address - Fax:916-897-9228
Practice Address - Street 1:7223 OVAR CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-3460
Practice Address - Country:US
Practice Address - Phone:916-647-3335
Practice Address - Fax:916-897-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347005337310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility