Provider Demographics
NPI:1114385325
Name:MOHAVE HEALTHCARE, INC.
Entity Type:Organization
Organization Name:MOHAVE HEALTHCARE, INC.
Other - Org Name:RIVER VALLEY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:PO BOX 3200
Mailing Address - Street 2:
Mailing Address - City:BIG RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:92242-3200
Mailing Address - Country:US
Mailing Address - Phone:760-665-5255
Mailing Address - Fax:520-333-3068
Practice Address - Street 1:149350 UKIAH TRL STE 103
Practice Address - Street 2:
Practice Address - City:BIG RIVER
Practice Address - State:CA
Practice Address - Zip Code:92242-9694
Practice Address - Country:US
Practice Address - Phone:760-665-5255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA751698Medicare Oscar/Certification