Provider Demographics
NPI:1104085737
Name:RIVERGATE NATURAL HEALTHCARE
Entity type:Organization
Organization Name:RIVERGATE NATURAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH CARE PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:LUM
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:970-382-9100
Mailing Address - Street 1:555 RIVERGATE STE B1-108
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7473
Mailing Address - Country:US
Mailing Address - Phone:970-382-9100
Mailing Address - Fax:970-385-4187
Practice Address - Street 1:555 RIVERGATE STE B1-108
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7473
Practice Address - Country:US
Practice Address - Phone:970-382-9100
Practice Address - Fax:970-385-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO029664251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management