Provider Demographics
NPI:1457157984
Name:RITTENBERY, SHANNON PAGE
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:PAGE
Last Name:RITTENBERY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 NEPTUNE DR
Mailing Address - Street 2:
Mailing Address - City:CARTER LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51510-1443
Mailing Address - Country:US
Mailing Address - Phone:531-721-6932
Mailing Address - Fax:
Practice Address - Street 1:2705 JOSEPHINE ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68147-1431
Practice Address - Country:US
Practice Address - Phone:531-721-6932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care