Provider Demographics
NPI:1447586649
Name:RIVERVIEW AT THE PARK, INC
Entity Type:Organization
Organization Name:RIVERVIEW AT THE PARK, INC
Other - Org Name:RIVERVIEW AT THE PARK CARE AND REHABILITAION CENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAFIQ
Authorized Official - Middle Name:M
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-335-1999
Mailing Address - Street 1:1100 PROGRESS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:STE. GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670
Mailing Address - Country:US
Mailing Address - Phone:573-883-3454
Mailing Address - Fax:573-883-7673
Practice Address - Street 1:1100 PROGRESS PARKWAY
Practice Address - Street 2:
Practice Address - City:STE. GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670
Practice Address - Country:US
Practice Address - Phone:573-883-3454
Practice Address - Fax:573-883-7673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265743Medicare Oscar/Certification