NPIMap

Organization Active NPI

River Valley Health

  • Federally Qualified Health Center (FQHC)
  • Lock Haven, PA
National Provider Identifier
1174254262
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RIVER VALLEY HEALTH
Practice address
124 E Walnut St Ste 2
Lock Haven, PA 17745-3522
Phone
(570) 567-5422
NPI assigned
Jun 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Max Houseknecht Jr.
Title
Cfo
Phone
(570) 567-5418

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

124 E Walnut St Ste 2
Lock Haven, PA 17745-3522

Mailing address

471 Hepburn St
Williamsport, PA 17701-6122
Phone (570) 567-5436

Other names 2

  • River Valley Health & Dental Center Doing business as
  • Susquehanna Community Health and Dental Clinic, Inc Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231221001130 PA Part A Provider - Federally Qualified Health Center (FQHC) 8527251230 Practice locations: Lock Haven, PA

Federally qualified health center certification: CCN 731187

Legal name
RIVER VALLEY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 20, 2023
Last certification
Dec 20, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 8, 2007 in PA
Enrollment address
124 E Walnut St
Ste 2
Lock Haven, PA 17745-3522

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2284850River Valley Health124 East Walnut Street, Lock Haven, PA 17745Provider-performed microscopyJun 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
River Valley Health5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

124 E Walnut St
Ste 2
Lock Haven, PA 17745
Phone (570) 567-5400

124 E Walnut St
Lock Haven, PA 17745

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kimberly Wetherhold Individual Corporate DirectorChair Feb 26, 2018
Mark Thompson Individual Corporate Director Mar 1, 2022
Velinda Smith Individual Corporate Director Jul 1, 2020
Abigail Shrom Individual Corporate Director Apr 1, 2017
Shameka Grey Individual Corporate Director Mar 1, 2023
James H Yoxtheimer Individual Corporate OfficerPresident and Ceo Sep 24, 2015
Christopher Ebner Individual Corporate DirectorSecretary Jul 1, 2019
Joshua Warfel Individual Corporate Director Jul 1, 2021
Erin Merrill Individual W-2 Managing Employee Mar 15, 2021
Ralph H. Kaiser Individual Corporate DirectorTreasurer Jul 1, 2020
Austin White Individual Corporate Director Nov 1, 2021
Max R Houseknecht Individual Corporate OfficerCfo Jan 13, 2017
Barbara J Vanaskie Individual Corporate Director Oct 1, 2021
Jean Myers Individual Corporate DirectorVice Chair Sep 24, 2018

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727136000000",
    "number": "1174254262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "471 HEPBURN ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177016122",
            "telephone_number": "570-567-5436",
            "fax_number": "570-601-4353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 E WALNUT ST STE 2",
            "city": "LOCK HAVEN",
            "state": "PA",
            "postal_code": "177453522",
            "telephone_number": "570-567-5422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER VALLEY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-21",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A",
        "authorized_official_last_name": "HOUSEKNECHT",
        "authorized_official_first_name": "MAX",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "570-567-5418",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "River Valley Health & Dental Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "River Valley Health & Dental Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Susquehanna Community Health and Dental Clinic, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Lock Haven, PA

Sources for this page

Verify at the official NPI Registry.