=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023014412
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVER VALLEY HOME CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2005
-----------------------------------------------------
Last Update Date | 04/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 916 8TH ST
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55024-1438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-460-4201
-----------------------------------------------------
Fax | 651-460-4208
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 916 8TH ST
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55024-1438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-460-4201
-----------------------------------------------------
Fax | 651-460-4208
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RACHELLE PARISEAU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-460-4201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------