Provider Demographics
NPI:1114241544
Name:NEW RIVER, INC
Entity Type:Organization
Organization Name:NEW RIVER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDUF
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:907-283-3038
Mailing Address - Street 1:750 BALEEN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-8839
Mailing Address - Country:US
Mailing Address - Phone:907-283-3038
Mailing Address - Fax:907-283-3055
Practice Address - Street 1:750 BALEEN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-8839
Practice Address - Country:US
Practice Address - Phone:907-283-3038
Practice Address - Fax:907-283-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-13
Last Update Date:2010-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100745310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility