Provider Demographics
NPI:1144387713
Name:RIVER CITIES COMMUNITY CLINIC INC.
Entity Type:Organization
Organization Name:RIVER CITIES COMMUNITY CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MAHLSTEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-704-9700
Mailing Address - Street 1:813 HANCOCK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-5032
Mailing Address - Country:US
Mailing Address - Phone:928-704-9700
Mailing Address - Fax:
Practice Address - Street 1:813 HANCOCK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5032
Practice Address - Country:US
Practice Address - Phone:928-704-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPENDING261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care