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General NPI Number Information
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NPI Number | 1962297200
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Entity Type | Organization
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Legal Business Name | RIVER FALLS QOZB
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 745 SYCAMORE ST
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City | RIVER FALLS
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State | WI
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Zip | 54022-4614
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Country | US
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Telephone | 715-997-3444
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Fax |
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Provider Business Mailing Address
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Address Line | 745 SYCAMORE ST
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City | RIVER FALLS
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State | WI
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Zip | 54022-4614
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Country | US
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Telephone | 715-997-3444
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | BRENDA JOHNSON
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Credential | MHA, RN, LNHA, LALD
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Telephone | 612-874-3477
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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 |
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License Number State |
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