Basic Information
| Provider Information | |||||||||
| NPI: | 1720215676 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RIVER HILLS VILLAGE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RIVER HILLS VILLAGE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9420 LIBERTY DR | ||||||||
| Address2: | |||||||||
| City: | PLEASANT VALLEY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640687757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164159700 | ||||||||
| FaxNumber: | 8164159770 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 VILLAGE CIR | ||||||||
| Address2: | |||||||||
| City: | KEOKUK | ||||||||
| State: | IA | ||||||||
| PostalCode: | 526322040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3195245772 | ||||||||
| FaxNumber: | 3195243001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2009 | ||||||||
| LastUpdateDate: | 06/18/2009 | ||||||||
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| AuthorizedOfficialLastName: | REDMAN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8164159700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0805283 | 05 | IA | MEDICAID |