Provider Demographics
NPI:1568579993
Name:RIVERVIEW HOSPITAL
Entity Type:Organization
Organization Name:RIVERVIEW HOSPITAL
Other - Org Name:ROLLING MEADOWS HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:CULLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-664-5400
Mailing Address - Street 1:604 RENNAKER ST
Mailing Address - Street 2:
Mailing Address - City:LA FONTAINE
Mailing Address - State:IN
Mailing Address - Zip Code:46940-9045
Mailing Address - Country:US
Mailing Address - Phone:765-981-2081
Mailing Address - Fax:765-981-4954
Practice Address - Street 1:604 RENNAKER ST
Practice Address - Street 2:
Practice Address - City:LA FONTAINE
Practice Address - State:IN
Practice Address - Zip Code:46940-9045
Practice Address - Country:US
Practice Address - Phone:765-981-2081
Practice Address - Fax:765-981-4954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100289950BMedicaid
IN155551Medicare Oscar/Certification