Provider Demographics
NPI:1811918436
Name:RIVERVIEW HEALTHCARE ASSOCIATION
Entity type:Organization
Organization Name:RIVERVIEW HEALTHCARE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-281-9756
Mailing Address - Street 1:323 S MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-1601
Mailing Address - Country:US
Mailing Address - Phone:218-281-9200
Mailing Address - Fax:218-281-9224
Practice Address - Street 1:1428 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:EAST GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-1605
Practice Address - Country:US
Practice Address - Phone:218-773-1390
Practice Address - Fax:218-773-1762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND5548OtherBCBS
ND12898Medicaid
MN244T9RIOtherBCBS
MN973488300Medicaid
ND5548OtherBCBS
MN244T9RIOtherBCBS
ND12898Medicaid
MN0921200001Medicare NSC
MN973488300Medicaid