Healthcare Provider Details

I. General information

NPI: 1114920147
Provider Name (Legal Business Name): RIVER OAKS HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 3RD ST
INTERNATIONAL FALLS MN
56649-2208
US

IV. Provider business mailing address

900 3RD ST
INTERNATIONAL FALLS MN
56649-2208
US

V. Phone/Fax

Practice location:
  • Phone: 218-283-3031
  • Fax: 218-283-4047
Mailing address:
  • Phone: 218-283-3031
  • Fax: 218-283-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number4579567
License Number StateMN

VIII. Authorized Official

Name: MRS. REBECCA LEE LARSEN-GRIFFIN
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 218-283-3031