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General NPI Number Information
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NPI Number | 1487650065
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Entity Type | Organization
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Legal Business Name | RIVER HOSPITAL, INC.
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 4 FULLER ST
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City | ALEXANDRIA BAY
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State | NY
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Zip | 13607-1316
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Country | US
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Telephone | 315-482-1116
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Fax | 315-482-7153
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Provider Business Mailing Address
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Address Line | 4 FULLER ST
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City | ALEXANDRIA BAY
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State | NY
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Zip | 13607-1316
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Country | US
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Telephone | 315-482-2511
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Fax | 315-482-4981
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | EMILY MASTALER
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Credential | PRESIDENT
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Telephone | 315-482-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 221001N
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License Number State | NY
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