Provider Demographics
NPI:1588660138
Name:RVP ENTERPRISES INC.
Entity Type:Organization
Organization Name:RVP ENTERPRISES INC.
Other - Org Name:REGENCY SQUARE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARNISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-753-6101
Mailing Address - Street 1:3501 DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-3641
Mailing Address - Country:US
Mailing Address - Phone:402-494-4273
Mailing Address - Fax:402-494-1267
Practice Address - Street 1:3501 DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3641
Practice Address - Country:US
Practice Address - Phone:402-494-4273
Practice Address - Fax:402-494-1267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF145310400000X
NE204002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE285076Medicare Oscar/Certification
NE=========00Medicaid