Provider Demographics
NPI:1508932211
Name:RIVER BEND RETAIL INC.
Entity Type:Organization
Organization Name:RIVER BEND RETAIL INC.
Other - Org Name:REFLECTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ALLYN
Authorized Official - Last Name:SWACKHAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-295-8505
Mailing Address - Street 1:904 GRAND CENTRAL AVENUE
Mailing Address - Street 2:STE D
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-2100
Mailing Address - Country:US
Mailing Address - Phone:304-295-8505
Mailing Address - Fax:
Practice Address - Street 1:904 GRAND CENTRAL AVENUE
Practice Address - Street 2:STE D
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-2100
Practice Address - Country:US
Practice Address - Phone:304-295-8505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4410220001Medicare ID - Type Unspecified