Healthcare Provider Details

I. General information

NPI: 1659045987
Provider Name (Legal Business Name): RIVERVIEW HEALTHCARE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MILL ST
FERTILE MN
56540-4300
US

IV. Provider business mailing address

323 S MINNESOTA ST
CROOKSTON MN
56716-1601
US

V. Phone/Fax

Practice location:
  • Phone: 218-945-6695
  • Fax:
Mailing address:
  • Phone: 218-281-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARI MOE
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 218-281-9293