Provider Demographics
NPI:1790783116
Name:RIVERVIEW NURSING HOME. INC.
Entity Type:Organization
Organization Name:RIVERVIEW NURSING HOME. INC.
Other - Org Name:RIVERVIEW HEALTHCARE COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CNHA, CAS
Authorized Official - Phone:401-821-6837
Mailing Address - Street 1:546 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-7852
Mailing Address - Country:US
Mailing Address - Phone:401-821-6837
Mailing Address - Fax:401-823-9840
Practice Address - Street 1:546 MAIN ST
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-7852
Practice Address - Country:US
Practice Address - Phone:401-821-6837
Practice Address - Fax:401-823-9840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI579313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI579Medicaid
RI402008OtherBLUE CHIP
RI507-2OtherBLUE CROSS
RI507-2OtherBLUE CROSS