Provider Demographics
NPI:1720102015
Name:RIVERVIEW SERVICES, INC.
Entity type:Organization
Organization Name:RIVERVIEW SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MALISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARROTT-STAHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-824-2091
Mailing Address - Street 1:750 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WANAMINGO
Mailing Address - State:MN
Mailing Address - Zip Code:55983-1478
Mailing Address - Country:US
Mailing Address - Phone:507-824-2091
Mailing Address - Fax:507-824-2249
Practice Address - Street 1:750 3RD AVE
Practice Address - Street 2:
Practice Address - City:WANAMINGO
Practice Address - State:MN
Practice Address - Zip Code:55983-1478
Practice Address - Country:US
Practice Address - Phone:150-782-4209
Practice Address - Fax:507-824-2249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 320900000X, 385H00000X
MN802152-1-RS315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA213682200Medicaid
MNA696815500Medicaid
MNA734457100Medicaid
MNA777460000Medicaid
MNA521523400Medicaid
MN545843900Medicaid
MNA053423400Medicaid