Provider Demographics
NPI:1619096187
Name:RIVERS OF LIFE
Entity Type:Organization
Organization Name:RIVERS OF LIFE
Other - Org Name:RIVERS OF LIFE CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOWANDA
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-286-8088
Mailing Address - Street 1:216 GLENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-8373
Mailing Address - Country:US
Mailing Address - Phone:252-286-8088
Mailing Address - Fax:252-747-8412
Practice Address - Street 1:216 GLENFIELD RD
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-8373
Practice Address - Country:US
Practice Address - Phone:252-286-8088
Practice Address - Fax:252-747-8412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-040-032320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805582Medicaid