Provider Demographics
NPI:1023985561
Name:RIVERIDGE
Entity type:Organization
Organization Name:RIVERIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR
Authorized Official - Prefix:
Authorized Official - First Name:ESTI
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUZANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-330-2157
Mailing Address - Street 1:175 ROUTE 70 STE 208
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-0936
Mailing Address - Country:US
Mailing Address - Phone:732-330-2157
Mailing Address - Fax:732-330-2157
Practice Address - Street 1:1333 WELLS ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-1543
Practice Address - Country:US
Practice Address - Phone:732-330-2157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility