Healthcare Provider Details

I. General information

NPI: 1609989326
Provider Name (Legal Business Name): DEER RIVER HEALTHCARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
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: 218-246-2900
  • Fax: 218-246-3057
Mailing address:
  • Phone: 218-246-2900
  • Fax: 218-246-3013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number331919
License Number StateMN

VIII. Authorized Official

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