Provider Demographics
NPI:1871725176
Name:RIVER VALLEY LIFE HOMECARE LLC
Entity type:Organization
Organization Name:RIVER VALLEY LIFE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:GALLANT
Authorized Official - Suffix:
Authorized Official - Credentials:EMTB/PSS/PCA
Authorized Official - Phone:207-357-3852
Mailing Address - Street 1:10 ROBBINS AVE
Mailing Address - Street 2:
Mailing Address - City:DIXFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04224-9526
Mailing Address - Country:US
Mailing Address - Phone:207-357-6499
Mailing Address - Fax:207-956-9086
Practice Address - Street 1:10 ROBBINS AVE
Practice Address - Street 2:
Practice Address - City:DIXFIELD
Practice Address - State:ME
Practice Address - Zip Code:04224-9526
Practice Address - Country:US
Practice Address - Phone:207-357-6499
Practice Address - Fax:207-956-9086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care