1720102015 NPI number — RIVERVIEW SERVICES, INC.

Table of content: (NPI 1720102015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720102015 NPI number — RIVERVIEW SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERVIEW SERVICES, INC.
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:
Provider Other Organization Name Type Code:
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:
1720102015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 3RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WANAMINGO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55983-1478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-824-2091
Provider Business Mailing Address Fax Number:
507-824-2249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WANAMINGO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55983-1478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
150-782-4209
Provider Business Practice Location Address Fax Number:
507-824-2249
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PARROTT-STAHNKE
Authorized Official First Name:
MALISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
507-824-2091

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: 802152-1-RS , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A213682200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: A696815500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: A734457100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: A777460000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: A521523400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 545843900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: A053423400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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