1417333428 NPI number — RIVER OAKS AT LAKE PEPIN, LLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417333428 NPI number — RIVER OAKS AT LAKE PEPIN, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVER OAKS AT LAKE PEPIN, 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:
1417333428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
815 N HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CITY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55041-1225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-345-2713
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 N HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55041-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-345-2713
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
DEAN
Authorized Official Title or Position:
VICE PRESIDENT OF OPERATIONS
Authorized Official Telephone Number:
763-258-6284

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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