Provider Demographics
NPI:1588408082
Name:RIVERS EDGE CARE HOME LLC
Entity type:Organization
Organization Name:RIVERS EDGE CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-281-4522
Mailing Address - Street 1:802 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-3044
Mailing Address - Country:US
Mailing Address - Phone:660-530-8414
Mailing Address - Fax:660-530-8421
Practice Address - Street 1:802 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3044
Practice Address - Country:US
Practice Address - Phone:660-530-8414
Practice Address - Fax:660-530-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-20
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility