Riverside Nursing - Centralia LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

RIVERSIDE NURSING - CENTRALIA LLC

Doing business as

Riverside Nursing & Rehabilitation Center

Practice address

1305 Alexander St
Centralia, WA 98531-1305

Phone

(360) 736-2823

Fax

(360) 736-1821

NPI assigned

Nov 17, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Dov E Jacobs

Title

Manager

Phone

(323) 678-4426

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Riverside Nursing & Rehabilitation Center Doing business as

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1952475485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 ALEXANDER ST",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985311305",
            "telephone_number": "360-736-2823",
            "fax_number": "360-736-1821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 ALEXANDER ST",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985311305",
            "telephone_number": "360-736-2823",
            "fax_number": "360-736-1821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE NURSING - CENTRALIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "DOV",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "323-678-4426",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4197000",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Nursing & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Timothy Eric Rise
• Tera Risenhoover, BA, AAC
• Tanya Risley
• Riverside Fire Authority
• Riverside Nursing - Centralia LLC
• Alejandra Maria Robbins
• Ona C Robbins, RN
• Brian David Roberts, D.D.S.
• Jodee M Roberts, LAT, ATC
• Donnia Maria Robinson

• Skilled Nursing Facility in Centralia, WA
• Providers in Centralia, WA by specialty
• Skilled Nursing Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.