Healthcare Provider Details

I. General information

NPI: 1851516389
Provider Name (Legal Business Name): DEER RIVER HEALTHCARE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 10TH AVENUE NE
DEER RIVER MN
56636-9700
US

IV. Provider business mailing address

115 10TH AVENUE NE
DEER RIVER MN
56636-9700
US

V. Phone/Fax

Practice location:
  • Phone: 218-246-2900
  • Fax: 218-246-3013
Mailing address:
  • Phone: 218-246-2900
  • Fax: 218-246-3013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. BRENDA K MOOS
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 218-246-3047