Provider Demographics
NPI:1720215676
Name:RIVER HILLS VILLAGE, LLC
Entity Type:Organization
Organization Name:RIVER HILLS VILLAGE, LLC
Other - Org Name:RIVER HILLS VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:REDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-415-9700
Mailing Address - Street 1:9420 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-7757
Mailing Address - Country:US
Mailing Address - Phone:816-415-9700
Mailing Address - Fax:816-415-9770
Practice Address - Street 1:20 VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-2040
Practice Address - Country:US
Practice Address - Phone:319-524-5772
Practice Address - Fax:319-524-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0805283Medicaid
IA0805283Medicaid