Provider Demographics
NPI:1801367982
Name:CHP LL RIVERVIEW FL TENANT LLC
Entity Type:Organization
Organization Name:CHP LL RIVERVIEW FL TENANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ESECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTSURIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-671-0222
Mailing Address - Street 1:1240 E INDEPENDENCE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4201
Mailing Address - Country:US
Mailing Address - Phone:417-877-1717
Mailing Address - Fax:
Practice Address - Street 1:8451 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5450
Practice Address - Country:US
Practice Address - Phone:813-671-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility