Provider Demographics
NPI:1184998361
Name:RIVER VALLEY HEALTH
Entity type:Organization
Organization Name:RIVER VALLEY HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESENDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSEKNECHT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:570-567-5400
Mailing Address - Street 1:471 HEPBURN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6122
Mailing Address - Country:US
Mailing Address - Phone:570-567-5400
Mailing Address - Fax:570-567-5421
Practice Address - Street 1:471 HEPBURN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6122
Practice Address - Country:US
Practice Address - Phone:570-567-5400
Practice Address - Fax:570-567-5421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X
PADS037699122300000X
PADS037012122300000X
PADH007970L124Q00000X
PADH069812124Q00000X
PADF002894126800000X
PADF003992126800000X
PAMD043794L207R00000X
PAOS006247L207R00000X
PAMD033431E207R00000X
PAMD010165E208000000X
PAMA001556L363A00000X
PASP007896363LF0000X
PASP003898B363LF0000X
PAMD435391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024416060002Medicaid
PA1024416060001Medicaid