Basic Information
| Provider Information | |||||||||
| NPI: | 1295726552 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN RIVERVIEW HEALTH CARE CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 87 S ROUTE 9W | ||||||||
| Address2: | |||||||||
| City: | HAVERSTRAW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109271700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454295381 | ||||||||
| FaxNumber: | 8454293001 | ||||||||
| Practice Location | |||||||||
| Address1: | 87 S ROUTE 9W | ||||||||
| Address2: | |||||||||
| City: | HAVERSTRAW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109271700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454295381 | ||||||||
| FaxNumber: | 8454293001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 02/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | CAHILL | ||||||||
| AuthorizedOfficialFirstName: | KYLE | ||||||||
| AuthorizedOfficialMiddleName: | OLOUGHLIN | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8454295381 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 4321302N | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 00308452 | 05 | NY | MEDICAID |