Provider Demographics
NPI:1306451679
Name:TRADITIONS AT RIVERTOWN PARK, LLC
Entity type:Organization
Organization Name:TRADITIONS AT RIVERTOWN PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:331-318-5200
Mailing Address - Street 1:3555 COPPER RIVER AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-9791
Mailing Address - Country:US
Mailing Address - Phone:616-258-2727
Mailing Address - Fax:616-258-2717
Practice Address - Street 1:3555 COPPER RIVER AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49418-9791
Practice Address - Country:US
Practice Address - Phone:616-258-2727
Practice Address - Fax:616-258-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility