Healthcare Provider Details

I. General information

NPI: 1790862829
Provider Name (Legal Business Name): RIVERVIEW LIFE SKILLS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 HIGHLANDER DR
JEFFERSONVILLE VT
05464-9591
US

IV. Provider business mailing address

197 HIGHLANDER DR
JEFFERSONVILLE VT
05464-9591
US

V. Phone/Fax

Practice location:
  • Phone: 802-644-8708
  • Fax: 802-644-6697
Mailing address:
  • Phone: 802-644-8708
  • Fax: 802-644-6697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number0214
License Number StateVT

VIII. Authorized Official

Name: MR. CHARLES JOHANNS ERICKSON SR.
Title or Position: PRESISDENT
Credential:
Phone: 802-644-8708