1902862592 NPI number — REGIONAL HEALTH CENTER OF RICHMOND, INC.

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 1902862592 NPI number — REGIONAL HEALTH CENTER OF RICHMOND, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL HEALTH CENTER OF RICHMOND, 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:
1902862592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 IVY AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-597-8999
Provider Business Mailing Address Fax Number:
320-597-8995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 IVY AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-597-8999
Provider Business Practice Location Address Fax Number:
320-597-8995
Provider Enumeration Date:
04/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOUREY
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
ANDREA
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
203-210-1663

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  003166 , 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: 647220600 . This is a "MEDICAL ASSISTANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31G09SP . This is a "BLUE CROSS BLUE SHIELD GR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 350049912 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 411508205 . This is a "AETNA & SIGNA PREFERRED O" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1016069 . This is a "HEALTH SERVICE MANAGEMENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31G09SP . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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