Provider Demographics
NPI:1730179367
Name:RIVERDALE GARDENS REHAB AND NURSING CENTER
Entity type:Organization
Organization Name:RIVERDALE GARDENS REHAB AND NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL ACCOUNTS RECEIVABLE MANAGR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DECOTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-335-3318
Mailing Address - Street 1:42 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4510
Mailing Address - Country:US
Mailing Address - Phone:413-733-3151
Mailing Address - Fax:413-731-9984
Practice Address - Street 1:42 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4510
Practice Address - Country:US
Practice Address - Phone:413-733-3151
Practice Address - Fax:413-731-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0068314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0929182Medicaid
MA=========OtherTAX ID NUMBER
MA0929182Medicaid