Provider Demographics
NPI:1457608242
Name:RIVENDEL INDEPENDENT LIVING, INC.
Entity Type:Organization
Organization Name:RIVENDEL INDEPENDENT LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-787-0402
Mailing Address - Street 1:2990 REGAL CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-1809
Mailing Address - Country:US
Mailing Address - Phone:877-787-0402
Mailing Address - Fax:866-831-3817
Practice Address - Street 1:2990 REGAL CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-1809
Practice Address - Country:US
Practice Address - Phone:877-787-0402
Practice Address - Fax:866-831-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health