Provider Demographics
NPI:1629274550
Name:RIVERVIEW HEALTH & REHABILITATION CENTER, INC
Entity Type:Organization
Organization Name:RIVERVIEW HEALTH & REHABILITATION CENTER, INC
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NHA #646
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:O
Authorized Official - Last Name:BURROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:912-398-3254
Mailing Address - Street 1:6711 LAROCHE AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406
Mailing Address - Country:US
Mailing Address - Phone:912-354-8225
Mailing Address - Fax:912-790-3238
Practice Address - Street 1:6711 LAROCHE AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-354-8225
Practice Address - Fax:912-790-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000040741CMedicaid
GA000040741CMedicaid