Provider Demographics
NPI:1518126135
Name:RIVARD, RICHARD M (CASE COORDINATOR)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:RIVARD
Suffix:
Gender:M
Credentials:CASE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CHRUCH ST
Mailing Address - Street 2:PO BOX 1231
Mailing Address - City:WRANGELL
Mailing Address - State:AK
Mailing Address - Zip Code:99929-1231
Mailing Address - Country:US
Mailing Address - Phone:907-274-2373
Mailing Address - Fax:
Practice Address - Street 1:333 CHURCH ST
Practice Address - Street 2:BOX 1231
Practice Address - City:WRANGELL
Practice Address - State:AK
Practice Address - Zip Code:99929-1231
Practice Address - Country:US
Practice Address - Phone:907-874-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCMG543171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK$$$$$$$$$Medicaid