1891762613 NPI number — RURAL HEALTH CARE, INC.

Table of content: (NPI 1891762613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891762613 NPI number — RURAL HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RURAL HEALTH CARE, 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:
1891762613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1302 RIVER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALATKA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32177-5042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-328-0108
Provider Business Mailing Address Fax Number:
386-325-1086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2503 PRESIDENT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALATKA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32177-5433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-328-7638
Provider Business Practice Location Address Fax Number:
386-328-9644
Provider Enumeration Date:
03/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPENCER
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
386-328-0108

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  20021180 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 029543400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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