Provider Demographics
NPI:1619544632
Name:RIVERBEAR HOMECARE LLC
Entity Type:Organization
Organization Name:RIVERBEAR HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:OSORIO
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:727-288-2345
Mailing Address - Street 1:9355 113TH ST UNIT 7935
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33775-6914
Mailing Address - Country:US
Mailing Address - Phone:727-288-2345
Mailing Address - Fax:
Practice Address - Street 1:2701 REGENCY OAKS BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1526
Practice Address - Country:US
Practice Address - Phone:727-288-2345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health