Provider Demographics
NPI:1225116452
Name:FOUR RIVERS RESOUCE SERVICES, INC.
Entity Type:Organization
Organization Name:FOUR RIVERS RESOUCE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SACKSTEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-841-2231
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-0249
Mailing Address - Country:US
Mailing Address - Phone:812-847-2231
Mailing Address - Fax:812-847-8836
Practice Address - Street 1:RT 1 BOX 295C
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-0249
Practice Address - Country:US
Practice Address - Phone:812-847-2231
Practice Address - Fax:812-847-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22000372235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty