Riverside Assisted Living LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

RIVERSIDE ASSISTED LIVING LLC

Doing business as

Riverside Place Assisted Living Community

Practice address

1151 W College St
Bainbridge, GA 39819-6400

Phone

(229) 248-1116

Fax

(229) 248-4115

NPI assigned

Jul 19, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Christopher Brogdon

Title

Manager

Phone

(770) 650-7086

Specialties & licenses 1

Addresses

Other names 1

• Riverside Place Assisted Living Community Doing business as

Locations

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952320111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 W COLLEGE ST",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398196400",
            "telephone_number": "229-248-1116",
            "fax_number": "229-248-4115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 W COLLEGE ST",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398196400",
            "telephone_number": "229-248-1116",
            "fax_number": "229-248-4115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROGDON",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-650-7086"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Place Assisted Living Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Breauina Shontell Reddick
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• Adult Care Home Facility in Bainbridge, GA
• Providers in Bainbridge, GA by specialty
• Adult Care Home Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.