Provider Demographics
NPI:1689072977
Name:ORANGE TREEIDENCE OPCO, LLC
Entity Type:Organization
Organization Name:ORANGE TREEIDENCE OPCO, LLC
Other - Org Name:RIVERWALK POST ACUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-447-9829
Mailing Address - Street 1:140 N UNION AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2956
Mailing Address - Country:US
Mailing Address - Phone:801-447-9829
Mailing Address - Fax:
Practice Address - Street 1:4000 HARRISON ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3514
Practice Address - Country:US
Practice Address - Phone:951-785-6060
Practice Address - Fax:951-785-6710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689072977Medicaid
CA1689072977Medicaid