Healthcare Provider Details

I. General information

NPI: 1366516403
Provider Name (Legal Business Name): DAB OF PELICAN RAPIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 CENTER AVE E
DILWORTH MN
56529-1410
US

IV. Provider business mailing address

701 CENTER AVE E
DILWORTH MN
56529-1410
US

V. Phone/Fax

Practice location:
  • Phone: 218-284-7772
  • Fax: 218-284-7774
Mailing address:
  • Phone: 218-284-7772
  • Fax: 218-284-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH A BORSTAD
Title or Position: OWNER DIRECTOR
Credential:
Phone: 218-284-7772