# RIVERSIDE SNF OPERATOR, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477118024
- **Authorized official:** JEFF KAGAN (OWNER)
- **Authorized official phone:** (410) 877-6630

## Contact information

- **Practice address:** 1123 BELCAMP GARTH, BELCAMP, MD 21017-1452
- **Practice address phone:** (410) 575-6400
- **Mailing address:** 1123 BELCAMP GARTH, BELCAMP, MD 21017-1452

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 05/08/2019
- **Last updated:** 05/08/2019