Provider Demographics
NPI:1366252728
Name:RIVERHEALTH L.L.C
Entity type:Organization
Organization Name:RIVERHEALTH L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, MBA
Authorized Official - Phone:570-294-2095
Mailing Address - Street 1:209 MOYERS GROVE RD
Mailing Address - Street 2:
Mailing Address - City:WAPWALLOPEN
Mailing Address - State:PA
Mailing Address - Zip Code:18660-2051
Mailing Address - Country:US
Mailing Address - Phone:570-294-2095
Mailing Address - Fax:
Practice Address - Street 1:795 EAST 16TH STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603
Practice Address - Country:US
Practice Address - Phone:570-294-2095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care