Provider Demographics
NPI:1669853560
Name:RIVERTOWN HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:RIVERTOWN HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELNUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-442-5554
Mailing Address - Street 1:113 RAINBOW INDUSTRIAL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-8901
Mailing Address - Country:US
Mailing Address - Phone:256-442-5554
Mailing Address - Fax:256-442-5354
Practice Address - Street 1:113 RAINBOW INDUSTRIAL BLVD STE B
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-8901
Practice Address - Country:US
Practice Address - Phone:256-442-5554
Practice Address - Fax:256-442-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain