Provider Demographics
NPI:1184871659
Name:FOUR RIVERS MANAGEMENT CORPORATION
Entity type:Organization
Organization Name:FOUR RIVERS MANAGEMENT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-821-3897
Mailing Address - Street 1:415 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1007
Mailing Address - Country:US
Mailing Address - Phone:213-484-0784
Mailing Address - Fax:213-484-4967
Practice Address - Street 1:415 S UNION AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1007
Practice Address - Country:US
Practice Address - Phone:213-484-0784
Practice Address - Fax:213-484-4967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA055704Medicare Oscar/Certification