Healthcare Provider Details

I. General information

NPI: 1366587966
Provider Name (Legal Business Name): RIVERVIEW HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MARINE DR
ANDERSON IN
46016-5937
US

IV. Provider business mailing address

2749 E COVENANTER DR
BLOOMINGTON IN
47401-5454
US

V. Phone/Fax

Practice location:
  • Phone: 765-649-0455
  • Fax: 812-334-0853
Mailing address:
  • Phone: 812-332-2265
  • Fax: 812-334-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060001601
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100267190A
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer

VIII. Authorized Official

Name: MR. KENT RODGERS
Title or Position: CFO
Credential:
Phone: 812-332-2265