Healthcare Provider Details

I. General information

NPI: 1912013541
Provider Name (Legal Business Name): RIVERVIEW HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 CENTRAL AVE
INDIANAPOLIS IN
46205
US

IV. Provider business mailing address

3114 E 46TH ST
INDIANAPOLIS IN
46205-2413
US

V. Phone/Fax

Practice location:
  • Phone: 317-920-7888
  • Fax: 317-920-4664
Mailing address:
  • Phone: 317-920-7888
  • Fax: 317-920-4664

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: MR. GARY OTT
Title or Position: PRESIDENT
Credential:
Phone: 765-664-5400