Provider Demographics
NPI:1790862829
Name:RIVERVIEW LIFE SKILLS CENTER, INC.
Entity type:Organization
Organization Name:RIVERVIEW LIFE SKILLS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESISDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JOHANNS
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:802-644-8708
Mailing Address - Street 1:197 HIGHLANDER DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05464-9591
Mailing Address - Country:US
Mailing Address - Phone:802-644-8708
Mailing Address - Fax:802-644-6697
Practice Address - Street 1:197 HIGHLANDER DR
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05464-9591
Practice Address - Country:US
Practice Address - Phone:802-644-8708
Practice Address - Fax:802-644-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0214320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities