Basic Information
| Provider Information | |||||||||
| NPI: | 1659045987 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVERVIEW HEALTHCARE ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 323 S MINNESOTA ST | ||||||||
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| City: | CROOKSTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 567161601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182819200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 S MILL ST | ||||||||
| Address2: | |||||||||
| City: | FERTILE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565404300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2189456695 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2021 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | MOE | ||||||||
| AuthorizedOfficialFirstName: | KARI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 2182819293 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.