Healthcare Provider Details

I. General information

NPI: 1487650065
Provider Name (Legal Business Name): RIVER HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FULLER ST
ALEXANDRIA BAY NY
13607-1316
US

IV. Provider business mailing address

4 FULLER ST
ALEXANDRIA BAY NY
13607-1316
US

V. Phone/Fax

Practice location:
  • Phone: 315-482-1116
  • Fax: 315-482-7153
Mailing address:
  • Phone: 315-482-2511
  • Fax: 315-482-4981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number221001N
License Number StateNY

VIII. Authorized Official

Name: EMILY MASTALER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PRESIDENT
Phone: 315-482-1110