Provider Demographics
NPI:1609177286
Name:RIVERVIEW HEALTHCARE PLAZA
Entity Type:Organization
Organization Name:RIVERVIEW HEALTHCARE PLAZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:ADM
Authorized Official - Phone:607-687-2594
Mailing Address - Street 1:510 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1620
Mailing Address - Country:US
Mailing Address - Phone:607-687-2594
Mailing Address - Fax:607-687-1561
Practice Address - Street 1:530 5TH AVE
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1620
Practice Address - Country:US
Practice Address - Phone:607-687-2594
Practice Address - Fax:607-687-1561
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVEVIEW MANOR HEALTHCARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-12
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5324302N261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)