Healthcare Provider Details

I. General information

NPI: 1932175791
Provider Name (Legal Business Name): RIVERVIEW HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COUNTY ROAD 800 WEST
LYONS IN
47443-0247
US

IV. Provider business mailing address

3249 E COVENANTER DR
BLOOMINGTON IN
47401-5479
US

V. Phone/Fax

Practice location:
  • Phone: 812-659-1440
  • Fax: 812-659-9995
Mailing address:
  • Phone: 812-332-2265
  • Fax: 812-334-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number050001441
License Number StateIN

VIII. Authorized Official

Name: DR. STEPHEN G. MOORE
Title or Position: PRESIDENT CEO
Credential: MD
Phone: 812-332-2265