Provider Demographics
NPI:1396832721
Name:ASSISTED LIVING AT NORTHERN RIVERVIEW
Entity Type:Organization
Organization Name:ASSISTED LIVING AT NORTHERN RIVERVIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SALMON
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-356-9880
Mailing Address - Street 1:89 S ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10927-1700
Mailing Address - Country:US
Mailing Address - Phone:845-429-4300
Mailing Address - Fax:
Practice Address - Street 1:89 S ROUTE 9W
Practice Address - Street 2:
Practice Address - City:HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10927-1700
Practice Address - Country:US
Practice Address - Phone:845-429-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY620E019310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01946698Medicaid