Healthcare Provider Details

I. General information

NPI: 1710205141
Provider Name (Legal Business Name): RIVERVIEW HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 EAST HANNA AVENUE
INDIANAPOLIS IN
46237
US

IV. Provider business mailing address

2749 E. COVENANTER DR.
BLOOMINGTON IN
47401
US

V. Phone/Fax

Practice location:
  • Phone: 317-788-4261
  • Fax: 317-781-4512
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 Number
License Number StateIN

VIII. Authorized Official

Name: BRITT GRANNAN
Title or Position: CONTROLLER
Credential:
Phone: 812-961-1864