1417199225 NPI number — RIVERVIEW BEHAVIORAL HEALTH, LLC

Table of content: (NPI 1417199225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417199225 NPI number — RIVERVIEW BEHAVIORAL HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERVIEW BEHAVIORAL HEALTH, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RIVERVIEW BEHAVIORAL HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417199225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6100 TOWER CIR STE 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-861-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 ARKANSAS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-772-5028
Provider Business Practice Location Address Fax Number:
870-772-5056
Provider Enumeration Date:
03/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
VP & SECRETARY
Authorized Official Telephone Number:
615-861-6000

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  AR4610 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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