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General NPI Number Information
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NPI Number | 1356308399
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Entity Type | Organization
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Legal Business Name | RIVERSIDE HEALTH CARE CENTER
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 1301 E BROADWAY ST
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City | MISSOULA
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State | MT
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Zip | 59802-4905
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Country | US
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Telephone | 406-721-0680
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Fax | 406-721-9788
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Provider Business Mailing Address
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Address Line | 1107 HAZELTINE BLVD SUITE 200
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City | CHASKA
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State | MN
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Zip | 55318-1009
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Country | US
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Telephone | 952-361-8000
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Fax | 952-361-8058
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | JAMES A WEICHERT
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Credential |
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Telephone | 952-361-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 9926
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License Number State | MT
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