Provider Demographics
NPI:1740491851
Name:RIVERBEND
Entity type:Organization
Organization Name:RIVERBEND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DIEDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DER VELDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-280-0965
Mailing Address - Street 1:2715 CHARLESTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-8163
Mailing Address - Country:US
Mailing Address - Phone:812-280-0965
Mailing Address - Fax:812-280-8094
Practice Address - Street 1:2715 CHARLESTOWN PIKE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-8163
Practice Address - Country:US
Practice Address - Phone:812-280-0965
Practice Address - Fax:812-280-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0Medicare UPIN