Healthcare Provider Details

I. General information

NPI: 1831164995
Provider Name (Legal Business Name): RIVERVIEW HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E COUNTY LINE RD
INDIANAPOLIS IN
46227-0962
US

IV. Provider business mailing address

3249 E COVENANTER DR
BLOOMINGTON IN
47401-5479
US

V. Phone/Fax

Practice location:
  • Phone: 317-885-7050
  • Fax: 317-885-1022
Mailing address:
  • Phone: 812-332-2265
  • Fax: 823-334-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number050002201
License Number StateIN

VIII. Authorized Official

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