Provider Demographics
NPI:1104083708
Name:RIVER VALLEY HOMES, INC.
Entity type:Organization
Organization Name:RIVER VALLEY HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:BLANESS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:507-726-6239
Mailing Address - Street 1:20176 528TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:56055-2286
Mailing Address - Country:US
Mailing Address - Phone:507-726-6239
Mailing Address - Fax:
Practice Address - Street 1:20176 528TH AVE
Practice Address - Street 2:
Practice Address - City:LAKE CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:56055-2286
Practice Address - Country:US
Practice Address - Phone:507-726-6239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1015968-1-WS251E00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251E00000XAgenciesHome Health