Healthcare Provider Details

I. General information

NPI: 1003178500
Provider Name (Legal Business Name): RURAL ENTERPRISE FOR ACCEPTABLE LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S 5TH ST STE 700
MARSHALL MN
56258-1298
US

IV. Provider business mailing address

109 S 5TH ST STE 700
MARSHALL MN
56258-1298
US

V. Phone/Fax

Practice location:
  • Phone: 507-532-2221
  • Fax: 507-532-2222
Mailing address:
  • Phone: 507-532-2221
  • Fax: 507-532-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: STEVEN K. THOVSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 507-532-2221