Healthcare Provider Details

I. General information

NPI: 1457332033
Provider Name (Legal Business Name): RIVERVIEW HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N BELL TRACE CIR
BLOOMINGTON IN
47408-4408
US

IV. Provider business mailing address

2749 E COVENANTER DR
BLOOMINGTON IN
47401-5454
US

V. Phone/Fax

Practice location:
  • Phone: 812-323-2858
  • Fax: 812-353-7584
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 Number155677
License Number StateIN

VIII. Authorized Official

Name: BRANT BUCCIARELLI
Title or Position: CFO
Credential:
Phone: 317-773-0760