Provider Demographics
NPI:1679659767
Name:RIVERVIEW HEALTHCARE ASSOCIATION
Entity Type:Organization
Organization Name:RIVERVIEW HEALTHCARE ASSOCIATION
Other - Org Name:RIVERVIEW RECOVERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-281-9756
Mailing Address - Street 1:323 S MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-1601
Mailing Address - Country:US
Mailing Address - Phone:218-281-9200
Mailing Address - Fax:
Practice Address - Street 1:721 S MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-1800
Practice Address - Country:US
Practice Address - Phone:218-281-9511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1679659767Medicaid