Provider Demographics
NPI:1932329133
Name:RIVSAL CORPORATION, INC.
Entity Type:Organization
Organization Name:RIVSAL CORPORATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHODA
Authorized Official - Middle Name:YTE
Authorized Official - Last Name:SALVADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-423-0226
Mailing Address - Street 1:6617 DAN DANCIGER RD.
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-4905
Mailing Address - Country:US
Mailing Address - Phone:817-423-0226
Mailing Address - Fax:817-423-0308
Practice Address - Street 1:6617 DAN DANCIGER RD.
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-4905
Practice Address - Country:US
Practice Address - Phone:817-423-0226
Practice Address - Fax:817-423-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120194310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility