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General NPI Number Information
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NPI Number | 1114241544
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Entity Type | Organization
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Legal Business Name | NEW RIVER, INC
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Dates
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Enumeration Date | 03/13/2010
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Last Update Date | 03/13/2010
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Provider Practice Location Address
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Address Line | 750 BALEEN AVE SUITE 1
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City | KENAI
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State | AK
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Zip | 99611-8839
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Country | US
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Telephone | 907-283-3038
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Fax | 907-283-3055
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Provider Business Mailing Address
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Address Line | 750 BALEEN AVE SUITE 1
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City | KENAI
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State | AK
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Zip | 99611-8839
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Country | US
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Telephone | 907-283-3038
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Fax | 907-283-3055
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | NICOLE BALDUF
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Credential | CNA
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Telephone | 907-283-3038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 100745
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License Number State | AK
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