1013138700 NPI number — REVERENCE FOR LIFE AND CONCERN FOR PEOPLE INC

Table of content: (NPI 1013138700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013138700 NPI number — REVERENCE FOR LIFE AND CONCERN FOR PEOPLE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REVERENCE FOR LIFE AND CONCERN FOR PEOPLE INC
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:
6
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:
1013138700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 116
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANITE FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56241-0116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-564-4911
Provider Business Mailing Address Fax Number:
320-564-3122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 WILLMAR AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLMAR
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56201-3484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-214-7744
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHIKS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXECUTIVE DIRECTOR-CEO
Authorized Official Telephone Number:
320-564-4911

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  1033404 , 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: 116018 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2U84PR . This is a "BCBS OP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1045707 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 331223 . This is a "VALU OPTIONS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 497418000 . This is a "MHCP WILLMAR" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 020506012 . This is a "PRIMEWEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5065657 . This is a "MEDICA-UBH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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