1114920147 NPI number — RIVER OAKS HOME HEALTH CARE LLC

Table of content: (NPI 1114920147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114920147 NPI number — RIVER OAKS HOME HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVER OAKS HOME HEALTH CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114920147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INTERNATIONAL FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56649-2208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-283-3031
Provider Business Mailing Address Fax Number:
218-283-4047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INTERNATIONAL FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56649-2208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-283-3031
Provider Business Practice Location Address Fax Number:
218-283-4047
Provider Enumeration Date:
05/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LARSEN-GRIFFIN
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
218-283-3031

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  4579567 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5900088 . This is a "MEDICA INSURANCE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2D75RI . This is a "BC/BS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 130913 . This is a "U-CARE INSURANCE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".