Provider Demographics
NPI:1770719965
Name:RIVER CITY HOSPICE, LLC
Entity type:Organization
Organization Name:RIVER CITY HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONTAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-201-9655
Mailing Address - Street 1:PO BOX 12571
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-2571
Mailing Address - Country:US
Mailing Address - Phone:208-777-2489
Mailing Address - Fax:208-777-2499
Practice Address - Street 1:3726 E MULLAN AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9852
Practice Address - Country:US
Practice Address - Phone:208-777-2489
Practice Address - Fax:208-777-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2011-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
131561Medicare Oscar/Certification