Provider Demographics
NPI:1972043677
Name:RIVERVIEW MANOR HEALTHCARE LLC
Entity Type:Organization
Organization Name:RIVERVIEW MANOR HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MORE THAN 5 PERCENT INTEREST
Authorized Official - Prefix:
Authorized Official - First Name:EPHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAHASKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:664-772-3668
Mailing Address - Street 1:99 W HAWTHORNE AVE
Mailing Address - Street 2:SUITE 508
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-6163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility