Healthcare Provider Details

I. General information

NPI: 1255445581
Provider Name (Legal Business Name): DEER RIVER HEALTHCARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 10TH AVE NE
DEER RIVER MN
56636-8795
US

IV. Provider business mailing address

115 10TH AVE NE
DEER RIVER MN
56636-8795
US

V. Phone/Fax

Practice location:
  • Phone: 218-246-3012
  • Fax: 218-246-3054
Mailing address:
  • Phone: 218-246-3012
  • Fax: 218-246-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number333483
License Number StateMN

VIII. Authorized Official

Name: KEVIN BOREN
Title or Position: CFO
Credential:
Phone: 218-786-1009