Healthcare Provider Details

I. General information

NPI: 1154501153
Provider Name (Legal Business Name): RCB REVISIONS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8090 UNIVERSITY AVE NE
FRIDLEY MN
55432-1862
US

IV. Provider business mailing address

8090 UNIVERSITY AVE NE
FRIDLEY MN
55432-1862
US

V. Phone/Fax

Practice location:
  • Phone: 763-571-6789
  • Fax: 763-574-9876
Mailing address:
  • Phone: 763-571-6789
  • Fax: 763-574-9876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number20040289
License Number StateMN

VIII. Authorized Official

Name: BETH ANN BEHLING
Title or Position: VICE PRESIDENT
Credential:
Phone: 763-571-6789