Rivendell Enterprises LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL6401H Issued in AZ

Legal business name

RIVENDELL ENTERPRISES LLC

Practice address

1901 W Joan de Arc Ave
Phoenix, AZ 85029-1616

Phone

(602) 993-1596

Fax

(602) 993-1440

NPI assigned

May 25, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Racquel P Young

Title

Owner/Manager

Phone

(602) 993-1596

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527206400000",
    "number": "1588155535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 W JOAN DE ARC AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850291616",
            "telephone_number": "602-993-1596",
            "fax_number": "602-993-1440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 W JOAN DE ARC AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850291616",
            "telephone_number": "602-993-1596",
            "fax_number": "602-993-1440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVENDELL ENTERPRISES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-25",
        "last_updated": "2018-05-25",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "RACQUEL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "602-993-1596",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "AL6401H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "959596",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Rivas, DNP
• Tiarah Rivas, RN
• Tristyn Rivas, LMSW
• Xyomara Emma Rivas, MD
• Brian R Riveland, M.D.
• Jesus Anthony Rivera Monge
• Rivera Pain Consultants PLLC
• Rivera Physician PLLC
• Luis E. Rivera Sarabia
• Tomas Rivera-Bonilla, MD

• Assisted Living Facility in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Assisted Living Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.