Provider Demographics
NPI:1962297200
Name:RIVER FALLS QOZB
Entity type:Organization
Organization Name:RIVER FALLS QOZB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, RN, LNHA, LALD
Authorized Official - Phone:612-874-3477
Mailing Address - Street 1:745 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-4614
Mailing Address - Country:US
Mailing Address - Phone:715-997-3444
Mailing Address - Fax:
Practice Address - Street 1:745 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-4614
Practice Address - Country:US
Practice Address - Phone:715-997-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility