Provider Demographics
NPI:1154752624
Name:RIVER TO RIVER COMMUNITY OF ANNA
Entity type:Organization
Organization Name:RIVER TO RIVER COMMUNITY OF ANNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTER HAMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-993-7533
Mailing Address - Street 1:151 DENNY DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-3290
Mailing Address - Country:US
Mailing Address - Phone:618-993-7531
Mailing Address - Fax:
Practice Address - Street 1:1500 SANDBAR DRIVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959
Practice Address - Country:US
Practice Address - Phone:618-993-7531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid