Provider Demographics
NPI:1730331372
Name:RIVERSIDE LIVING PROPERTIES LLC
Entity type:Organization
Organization Name:RIVERSIDE LIVING PROPERTIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENNA
Authorized Official - Middle Name:BEACH
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:940-256-0097
Mailing Address - Street 1:701 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GOREE
Mailing Address - State:TX
Mailing Address - Zip Code:76363-4233
Mailing Address - Country:US
Mailing Address - Phone:940-256-0097
Mailing Address - Fax:
Practice Address - Street 1:840 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:MUNDAY
Practice Address - State:TX
Practice Address - Zip Code:76371-1840
Practice Address - Country:US
Practice Address - Phone:940-422-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility