Provider Demographics
NPI:1578664272
Name:NEWCOMERSTOWN PROGRESS CORPORATION
Entity Type:Organization
Organization Name:NEWCOMERSTOWN PROGRESS CORPORATION
Other - Org Name:RIVERSIDE MANOR NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:N
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-498-5165
Mailing Address - Street 1:1100 E STATE RD
Mailing Address - Street 2:
Mailing Address - City:NEWCOMERSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43832-9446
Mailing Address - Country:US
Mailing Address - Phone:740-498-5165
Mailing Address - Fax:740-498-6127
Practice Address - Street 1:1100 E STATE RD
Practice Address - Street 2:
Practice Address - City:NEWCOMERSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43832-9446
Practice Address - Country:US
Practice Address - Phone:740-498-5165
Practice Address - Fax:740-498-6127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1665314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0367697Medicaid
OH0367697Medicaid