Provider Demographics
NPI:1386819894
Name:RIVERVIEW HEALTHCARE ASSOCIATION
Entity Type:Organization
Organization Name:RIVERVIEW HEALTHCARE ASSOCIATION
Other - Org Name:RIVERVIEW RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-281-9408
Mailing Address - Street 1:323 SOUTH MN STREET
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716
Mailing Address - Country:US
Mailing Address - Phone:800-584-9226
Mailing Address - Fax:
Practice Address - Street 1:323 SOUTH MN ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-0323
Practice Address - Country:US
Practice Address - Phone:800-584-9226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN689434800Medicaid