Provider Demographics
NPI:1912933367
Name:RIVERSIDE NURSING CENTER OF THOMASTON LLC
Entity Type:Organization
Organization Name:RIVERSIDE NURSING CENTER OF THOMASTON LLC
Other - Org Name:RIVERSIDE HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-647-8161
Mailing Address - Street 1:101 OLD TALBOTTON RD
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-4640
Mailing Address - Country:US
Mailing Address - Phone:706-647-8161
Mailing Address - Fax:706-646-2875
Practice Address - Street 1:101 OLD TALBOTTON RD
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-4640
Practice Address - Country:US
Practice Address - Phone:706-647-8161
Practice Address - Fax:706-646-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-145-1781314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
51001369 001OtherBCBS
GA000140346AMedicaid
51001369 001OtherBCBS