Provider Demographics
NPI:1639607484
Name:NEW RIVERRANCH
Entity Type:Organization
Organization Name:NEW RIVERRANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:REVEREND
Authorized Official - Phone:304-574-1058
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25840-0178
Mailing Address - Country:US
Mailing Address - Phone:304-574-1058
Mailing Address - Fax:304-574-3427
Practice Address - Street 1:PO BOX 178
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-0178
Practice Address - Country:US
Practice Address - Phone:304-574-1058
Practice Address - Fax:304-574-3724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1040-25233104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances