Provider Demographics
NPI:1922067222
Name:ECA RIVERVIEW LC
Entity Type:Organization
Organization Name:ECA RIVERVIEW LC
Other - Org Name:RIVERVIEW MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHENSVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-362-8916
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:52767-0503
Mailing Address - Country:US
Mailing Address - Phone:563-332-4600
Mailing Address - Fax:563-332-1493
Practice Address - Street 1:17990 SPENCER ROAD
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:IA
Practice Address - Zip Code:52767
Practice Address - Country:US
Practice Address - Phone:563-332-4600
Practice Address - Fax:563-332-1493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA820046313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16D0667178OtherCLIA
IA0808410Medicaid
IA16D0667178OtherCLIA