Provider Demographics
NPI:1053456665
Name:RIVERVIEW HOSPITAL
Entity Type:Organization
Organization Name:RIVERVIEW HOSPITAL
Other - Org Name:RAWLINS HOUSE HEALTH & LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-332-2265
Mailing Address - Street 1:2749 E COVENANTER DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5454
Mailing Address - Country:US
Mailing Address - Phone:812-332-2265
Mailing Address - Fax:812-334-0853
Practice Address - Street 1:300 JH WALKER DR
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-8730
Practice Address - Country:US
Practice Address - Phone:765-778-7501
Practice Address - Fax:765-778-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060002481314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200956330AMedicaid
IN100291470AMedicaid
IN200956330AMedicaid