Provider Demographics
NPI:1952146755
Name:RIVERS WELLNESS
Entity type:Organization
Organization Name:RIVERS WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:W
Authorized Official - Last Name:YIMOYINES
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:717-825-5275
Mailing Address - Street 1:40 CROSSHILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3721
Mailing Address - Country:US
Mailing Address - Phone:717-825-5275
Mailing Address - Fax:
Practice Address - Street 1:415 SILAS DEANE HWY STE 105
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2119
Practice Address - Country:US
Practice Address - Phone:717-825-5275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty