Healthcare Provider Details

I. General information

NPI: 1275678864
Provider Name (Legal Business Name): RIVERVIEW HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 SHERIDAN RD
NOBLESVILLE IN
46062-8723
US

IV. Provider business mailing address

2749 E COVENANTER DR
BLOOMINGTON IN
47401-5454
US

V. Phone/Fax

Practice location:
  • Phone: 317-770-3400
  • Fax: 317-776-5950
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 Number060005511
License Number StateIN

VIII. Authorized Official

Name: MR. KENT RODGERS
Title or Position: CFO
Credential:
Phone: 812-332-2235