Provider Demographics
NPI:1578522439
Name:RIVERVIEW HOSPITAL
Entity Type:Organization
Organization Name:RIVERVIEW HOSPITAL
Other - Org Name:MORRISTOWN MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-332-2265
Mailing Address - Street 1:868 SOUTH WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46161-9633
Mailing Address - Country:US
Mailing Address - Phone:765-763-6012
Mailing Address - Fax:765-763-7261
Practice Address - Street 1:868 SOUTH WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:IN
Practice Address - Zip Code:46161-9633
Practice Address - Country:US
Practice Address - Phone:765-763-6012
Practice Address - Fax:765-763-7261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN050004221314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000108756OtherBLUE CROSS BLUE SHIELD
IN100291030AMedicaid
IN000000108756OtherBLUE CROSS BLUE SHIELD