Healthcare Provider Details

I. General information

NPI: 1295266898
Provider Name (Legal Business Name): DEER RIVER HEALTHCARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 05/20/2019
Certification Date:
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:
Mailing address:
  • Phone: 218-246-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0064
License Number StateMN

VIII. Authorized Official

Name: STEVEN FELTMAN
Title or Position: CFO
Credential:
Phone: 218-742-8662