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General NPI Number Information
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NPI Number | 1609177286
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Entity Type | Organization
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Legal Business Name | RIVERVIEW HEALTHCARE PLAZA
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Dates
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Enumeration Date | 11/12/2010
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Last Update Date | 07/14/2011
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Provider Practice Location Address
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Address Line | 530 5TH AVE
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City | OWEGO
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State | NY
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Zip | 13827-1620
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Country | US
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Telephone | 607-687-2594
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Fax | 607-687-1561
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Provider Business Mailing Address
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Address Line | 510 5TH AVE
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City | OWEGO
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State | NY
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Zip | 13827-1620
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Country | US
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Telephone | 607-687-2594
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Fax | 607-687-1561
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. CHARLES LEWIS
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Credential | ADM
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Telephone | 607-687-2594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | 5324302N
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License Number State | NY
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