Provider Demographics
NPI:1427490887
Name:RIVERSIDE AFH
Entity type:Organization
Organization Name:RIVERSIDE AFH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:AYRES
Authorized Official - Suffix:
Authorized Official - Credentials:RCP, RPSGT
Authorized Official - Phone:360-597-3835
Mailing Address - Street 1:7410 SE EVERGREEN HWY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1718
Mailing Address - Country:US
Mailing Address - Phone:360-597-3835
Mailing Address - Fax:360-597-4654
Practice Address - Street 1:7410 SE EVERGREEN HWY
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1718
Practice Address - Country:US
Practice Address - Phone:360-597-3835
Practice Address - Fax:360-597-4654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA566200310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility