Organization Name: | RIVERVIEW HEALTHCARE ASSOCIATION |
NPI Number: | 1487945853 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROSS MATLACK (CEO) |
Mailing Address: | 1428 Central Ave Ne East Grand Forks |
State: | MN US |
Postal Code: | 567211605 |
Phone Number: | 8667731390 |
Fax Number: | |
NPI Enumeration Date: | 04/20/2011 |
NPI Last Update Date: | 04/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |