Provider Demographics
NPI:1538965330
Name:1102 RIVER ROAD OPCO LLC
Entity type:Organization
Organization Name:1102 RIVER ROAD OPCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-719-5098
Mailing Address - Street 1:1102 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2436
Mailing Address - Country:US
Mailing Address - Phone:830-249-2799
Mailing Address - Fax:830-541-7265
Practice Address - Street 1:1102 RIVER RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2436
Practice Address - Country:US
Practice Address - Phone:830-249-2799
Practice Address - Fax:830-541-7265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility