Provider Demographics
NPI:1649544701
Name:RIVERDALE ASSISTED LIVING FACILITY
Entity type:Organization
Organization Name:RIVERDALE ASSISTED LIVING FACILITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:SUZZETTEE
Authorized Official - Last Name:WESTBROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-491-2426
Mailing Address - Street 1:5100 STAGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3161
Mailing Address - Country:US
Mailing Address - Phone:901-388-3545
Mailing Address - Fax:901-388-3423
Practice Address - Street 1:6880 E RAINES RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-5404
Practice Address - Country:US
Practice Address - Phone:901-795-4495
Practice Address - Fax:901-729-6639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN310400000X
TN112000424310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility