Provider Demographics
NPI:1629013404
Name:RIVERLANDS HOME GROUP, LLC
Entity Type:Organization
Organization Name:RIVERLANDS HOME GROUP, LLC
Other - Org Name:CHATEAU ST. JAMES REHAB AND RETIREMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOULWARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-855-4424
Mailing Address - Street 1:1980 RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:LUTCHER
Mailing Address - State:LA
Mailing Address - Zip Code:70071
Mailing Address - Country:US
Mailing Address - Phone:225-869-5725
Mailing Address - Fax:225-869-4009
Practice Address - Street 1:1980 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071
Practice Address - Country:US
Practice Address - Phone:225-869-5725
Practice Address - Fax:225-869-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1017314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA31201OtherBLUE CROSS BLUE SHIELD
LA31201OtherBLUE CROSS BLUE SHIELD