MEDICARE: RIVER CITY TRAIL D/B/A CARING MATTERS HOME CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	371615	MN

General Provider Information

NPI Number	:	1104216837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER CITY TRAIL D/B/A CARING MATTERS HOME CARE

Provider Business Mailing Address
First Line	:	10040 UNION TERRACE LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-3441
Country	:	US
Telephone Number	:	763-445-9199
Fax Number	:

Provider Business Practice Location Address
First Line	:	10040 UNION TERRACE LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-3441
Country	:	US
Telephone Number	:	763-445-9199
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. DAMIEN DEZURIK
Credential	:
Telephone Number	:	763-445-9199

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	02/03/2015

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