Basic Information
Provider Information | |||||||||
NPI: | 1073858551 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | THE RIVERS OPERATIONS LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | THE RIVERS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 400 LOCUST ST STE 820 | ||||||||
Address2: |   | ||||||||
City: | DES MOINES | ||||||||
State: | IA | ||||||||
PostalCode: | 503092334 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5158754500 | ||||||||
FaxNumber: | 5158754780 | ||||||||
Practice Location | |||||||||
Address1: | 11151 RIVER HILLS DR | ||||||||
Address2: |   | ||||||||
City: | BURNSVILLE | ||||||||
State: | MN | ||||||||
PostalCode: | 553373266 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9528908553 | ||||||||
FaxNumber: | 9528959887 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/10/2012 | ||||||||
LastUpdateDate: | 12/10/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BUXO | ||||||||
AuthorizedOfficialFirstName: | JUDI | ||||||||
AuthorizedOfficialMiddleName: | L | ||||||||
AuthorizedOfficialTitleorPosition: | SR VP-DIR OF ASSET MANAGEMENT | ||||||||
AuthorizedOfficialTelephone: | 5158754500 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X |   |   | Y |   | Nursing & Custodial Care Facilities | Assisted Living Facility |   |
No ID Information.