Healthcare Provider Details

I. General information

NPI: 1184846552
Provider Name (Legal Business Name): RIVER VALLEY CSD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 HACKBERRY STREET
CORRECTIONVILLE IA
51016
US

IV. Provider business mailing address

916 HACKBERRY STREET
CORRECTIONVILLE IA
51016
US

V. Phone/Fax

Practice location:
  • Phone: 712-372-4420
  • Fax: 712-372-4677
Mailing address:
  • Phone: 712-372-4420
  • Fax: 712-372-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONITA LAN JOENS
Title or Position: SUPERINTENDENT
Credential:
Phone: 712-372-4420