Healthcare Provider Details

I. General information

NPI: 1720102015
Provider Name (Legal Business Name): RIVERVIEW SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 3RD AVE
WANAMINGO MN
55983-1478
US

IV. Provider business mailing address

750 3RD AVE
WANAMINGO MN
55983-1478
US

V. Phone/Fax

Practice location:
  • Phone: 150-782-4209
  • Fax: 507-824-2249
Mailing address:
  • Phone: 507-824-2091
  • Fax: 507-824-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number802152-1-RS
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MALISSA PARROTT-STAHNKE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 507-824-2091