Healthcare Provider Details

I. General information

NPI: 1093152423
Provider Name (Legal Business Name): DEER RIVER HEALTHCARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 GOLF COURSE RD
GRAND RAPIDS MN
55744-3555
US

IV. Provider business mailing address

1542 GOLF COURSE RD
GRAND RAPIDS MN
55744-3555
US

V. Phone/Fax

Practice location:
  • Phone: 218-999-7099
  • Fax: 218-999-7099
Mailing address:
  • Phone: 218-999-7099
  • Fax: 218-999-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number361503
License Number StateMN

VIII. Authorized Official

Name: BRENDA MOOS
Title or Position: MANAGER-REVENUE INTEGRITY
Credential:
Phone: 218-246-3047