Provider Demographics
NPI:1518269653
Name:OXFORD, JACKSON, RIVER ROCK
Entity Type:Organization
Organization Name:OXFORD, JACKSON, RIVER ROCK
Other - Org Name:RIVER ROCK ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARNISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-753-6101
Mailing Address - Street 1:3000 W BIG TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-9138
Mailing Address - Country:US
Mailing Address - Phone:307-734-0500
Mailing Address - Fax:307-732-4275
Practice Address - Street 1:3000 W BIG TRAIL DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-9138
Practice Address - Country:US
Practice Address - Phone:307-734-0500
Practice Address - Fax:307-732-7275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10336310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility