Riverside Nursing and Rehabilitation Center LLC
Organization Active NPI Skilled Nursing Facility · Riverside, MO
NPI 1497972624 · NPPES record last updated Dec 8, 2023
Key facts
- NPI
- 1497972624
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- RIVERSIDE NURSING AND REHABILITATION CENTER LLC
- Practice address
- 4700 NW Cliffview Drive
Riverside, MO 64150-1237 - Phone
- (816) 741-5105
- Fax
- (816) 741-5281
- NPI assigned
- Apr 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Norbert A Bennett
- Title
- Ceo
- Phone
- (716) 662-4955
Facilities with the same owner 30
Practitioners 4
-
Steven Michael Cicero, D.O.
-
Srinath Tadakamalla, M.D
-
Shyam K. Akkulugari, MD., MPH
Affiliated clinicians 1
Medicare Care Compare: Nursing home
- Listed as
- Pinnacle Point Wellness & Rehabilitation
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★☆☆☆ 2 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Aug 1, 1989
- Medicare certification status
- Active
- Certified beds
- 180 · 111.7 residents per day on average
- Penalties (3 years)
- 3 · fines totaling $52,878
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Skilled nursing facility certification: CCN 265379
- Legal name
- RIVERSIDE NURSING AND REHABILITATION CENTER LLC
- Doing business as
- RIVERSIDE NURSING AND REHABILITATION CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 1, 1989
- Last certification
- Apr 10, 2025
- Beds
- 180
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- May 1, 2007 in MO
- Enrollment address
- 4700 NW Cliff View Dr
Riverside, MO 64150-1237
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Jennifer Jennings |
W-2 Managing Employee |
Feb 14, 2018 | 100% |
| Donald T Denz Irrv TR |
5% Or Greater Indirect Ownership Interest | May 23, 2008 | 6% |
| Norbert a Bennett |
5% Or Greater Indirect Ownership Interest | May 1, 2007 | 32.45% |
| Donald T Denz |
5% Or Greater Indirect Ownership Interest | May 1, 2007 | 44% |
| Norbert a Bennett Irrv TR Fbo Grandchildren |
5% Or Greater Indirect Ownership Interest | May 23, 2008 | 6% |
| Norbert a Bennett Irrv TR Fbo Children |
5% Or Greater Indirect Ownership Interest | May 23, 2008 | 12% |
| D&N, LLC |
5% Or Greater Direct Ownership Interest | May 1, 2007 | 50% |
| DTD HC LLC |
5% Or Greater Direct Ownership Interest | May 1, 2007 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070622000167 | MO | Part a Provider - Skilled Nursing Facility | 9638278237 | Practice locations: Riverside, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
4700 NW Cliffview Drive
Riverside, MO 64150-1237
Mailing address
PO Box 428
Orchard Park, NY 14127
Phone (716) 662-4955
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102691607 | Medicaid | MO |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | ENDPOINT | Other | The White Stone Group d/b/a Vyne Medical |
Other providers in Riverside, MO
- Phillips Family Pharmacy, LLC
- Pinnacle Point Wellness & Rehabilitation LLC
- Polaris Specialty Pharmacy LLC
- Polaris Specialty Pharmacy LLC
- Jessie Brei Riojas
- Riverside Pharmacy Associates, LLC
- Riverside Pharmacy Associates, LLC
- Abigail Hardy Rives
- Josie Deeanna Ross
- Nicholas Adam Rudloff
All providers in Riverside, MO · Skilled Nursing Facility in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.