Basic Information
| Provider Information | |||||||||
| NPI: | 1730692773 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVER VISTA HEALTH AND WELLNESS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 ASHWOOD DR STE 200 | ||||||||
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| City: | BLUE ASH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452412424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134897100 | ||||||||
| FaxNumber: | 5134897199 | ||||||||
| Practice Location | |||||||||
| Address1: | 1599 ALUM CREEK DRIVE | ||||||||
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| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147153933 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2017 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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| AuthorizedOfficialLastName: | STOLTZ | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5134897100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
No ID Information.