Basic Information
| Provider Information | |||||||||
| NPI: | 1457332033 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVERVIEW HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2749 E COVENANTER DR | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474015454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123322265 | ||||||||
| FaxNumber: | 8123340853 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 N BELL TRACE CIR | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474084408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123232858 | ||||||||
| FaxNumber: | 8123537584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 03/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | BUCCIARELLI | ||||||||
| AuthorizedOfficialFirstName: | BRANT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3177730760 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 155677 | IN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 201224380A | 05 | IN | MEDICAID |