Healthcare Provider Details

I. General information

NPI: 1003851312
Provider Name (Legal Business Name): RIVER VALLEY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MAIN ST
POUGHKEEPSIE NY
12601-3018
US

IV. Provider business mailing address

140 MAIN ST
POUGHKEEPSIE NY
12601-3018
US

V. Phone/Fax

Practice location:
  • Phone: 845-454-7600
  • Fax: 718-461-9484
Mailing address:
  • Phone: 845-454-7600
  • Fax: 718-461-9484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1302307N
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02194985
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier02993497
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: MR. MOSHE KALTER
Title or Position: PRESIDENT
Credential:
Phone: 718-961-1212