Healthcare Provider Details

I. General information

NPI: 1033819149
Provider Name (Legal Business Name): RIVER VALLEY IN-HOME SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LEROUX ST
DONIPHAN MO
63935-1038
US

IV. Provider business mailing address

11796 WESTLINE INDUSTRIAL DR
SAINT LOUIS MO
63146-3402
US

V. Phone/Fax

Practice location:
  • Phone: 314-282-2957
  • Fax:
Mailing address:
  • Phone: 314-282-2957
  • Fax: 314-282-2967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN P BOSEN
Title or Position: PRESIDENT
Credential:
Phone: 314-282-2957