MEDICARE: RIVERLAND HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1801685334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERLAND HEALTH SERVICES

Provider Business Mailing Address
First Line	:	15432 EAMES WAY
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-5534
Country	:	US
Telephone Number	:	952-228-4504
Fax Number	:

Provider Business Practice Location Address
First Line	:	11487 VALLEY VIEW RD
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-3617
Country	:	US
Telephone Number	:	952-228-4504
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NUH AHMED JAMA
Credential	:
Telephone Number	:	952-228-4504

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	05/01/2025

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