Provider Demographics
NPI:1639719511
Name:RIVERQUEST GROUP HOME, INC.
Entity Type:Organization
Organization Name:RIVERQUEST GROUP HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-252-8915
Mailing Address - Street 1:390 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7946
Mailing Address - Country:US
Mailing Address - Phone:907-262-9600
Mailing Address - Fax:907-262-6400
Practice Address - Street 1:399 LOVERS LN
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7946
Practice Address - Country:US
Practice Address - Phone:907-262-9600
Practice Address - Fax:907-262-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No177F00000XOther Service ProvidersLodging