Provider Demographics
NPI:1366889040
Name:NEW RIVER COMMUNITY HEALTH CARE, INC
Entity type:Organization
Organization Name:NEW RIVER COMMUNITY HEALTH CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIETRANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-964-7732
Mailing Address - Street 1:495 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-1731
Mailing Address - Country:US
Mailing Address - Phone:386-496-3211
Mailing Address - Fax:386-496-1599
Practice Address - Street 1:495 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-1731
Practice Address - Country:US
Practice Address - Phone:386-496-3211
Practice Address - Fax:386-496-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty