MEDICARE: RIVERVIEW HEALTHCARE ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		MN

General Provider Information

NPI Number	:	1962515940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERVIEW HEALTHCARE ASSOCIATION

Provider Business Mailing Address
First Line	:	311 BROADWAY AVE NE
Second Line	:
City	:	RED LAKE FALLS
State	:	MN
Zip	:	56750-4224
Country	:	US
Telephone Number	:	218-253-2157
Fax Number	:	218-253-4676

Provider Business Practice Location Address
First Line	:	311 BROADWAY AVE NE
Second Line	:
City	:	RED LAKE FALLS
State	:	MN
Zip	:	56750-4224
Country	:	US
Telephone Number	:	218-253-2157
Fax Number	:	218-253-4676

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. CARRIE MICHALSKI
Credential	:
Telephone Number	:	218-253-2157

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	08/22/2020

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