Provider Demographics
NPI:1740538768
Name:RIVER OF LIFE HEALTH CENTER
Entity type:Organization
Organization Name:RIVER OF LIFE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD (CANDIDATE)
Authorized Official - Phone:717-684-4363
Mailing Address - Street 1:291 S 4TH ST
Mailing Address - Street 2:PO BOX 388
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-1731
Mailing Address - Country:US
Mailing Address - Phone:717-684-9000
Mailing Address - Fax:
Practice Address - Street 1:291 S 4TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-1731
Practice Address - Country:US
Practice Address - Phone:717-684-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care