Provider Demographics
NPI:1861854242
Name:RIVERWOOD-LTC, LLC
Entity Type:Organization
Organization Name:RIVERWOOD-LTC, LLC
Other - Org Name:RIVERWOOD HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER.CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-381-2810
Mailing Address - Street 1:10945 STATE BRIDGE RD
Mailing Address - Street 2:SUITE 401-470
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8164
Mailing Address - Country:US
Mailing Address - Phone:678-381-2820
Mailing Address - Fax:678-381-2810
Practice Address - Street 1:600 BACON ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TX
Practice Address - Zip Code:77864-2575
Practice Address - Country:US
Practice Address - Phone:936-348-9097
Practice Address - Fax:936-348-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility