Provider Demographics
NPI:1902114192
Name:CROSS SNF OPERATIONS LLC
Entity Type:Organization
Organization Name:CROSS SNF OPERATIONS LLC
Other - Org Name:RIVER RIDGE REHABILITATION AND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-443-8167
Mailing Address - Street 1:1100 MARTIN DR E
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-3500
Mailing Address - Country:US
Mailing Address - Phone:870-238-4400
Mailing Address - Fax:870-238-9425
Practice Address - Street 1:1100 MARTIN DR E
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3500
Practice Address - Country:US
Practice Address - Phone:870-238-4400
Practice Address - Fax:870-238-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR045157Medicare Oscar/Certification