Provider Demographics
NPI:1821507930
Name:RIVERWOOD GROUP, LLC
Entity Type:Organization
Organization Name:RIVERWOOD GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QUALITY MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-339-1436
Mailing Address - Street 1:42 GODLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29920-5113
Mailing Address - Country:US
Mailing Address - Phone:402-033-9143
Mailing Address - Fax:402-592-5901
Practice Address - Street 1:42 GODLEY RD
Practice Address - Street 2:
Practice Address - City:SAINT HELENA ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29920-5113
Practice Address - Country:US
Practice Address - Phone:402-033-9143
Practice Address - Fax:402-592-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder