Healthcare Provider Details

I. General information

NPI: 1710011234
Provider Name (Legal Business Name): REHOBOTH DISABLED & ELDERLY FOSTER CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3696 110TH ST NW
ORONOCO MN
55960-2147
US

IV. Provider business mailing address

3696 110TH ST NW
ORONOCO MN
55960-2147
US

V. Phone/Fax

Practice location:
  • Phone: 507-319-7444
  • Fax: 507-367-2829
Mailing address:
  • Phone: 507-319-7444
  • Fax: 507-367-2829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number1005701-2-AFC
License Number StateMN

VIII. Authorized Official

Name: MS. DEANN RUTH SCHRIMPF
Title or Position: OWNER,OPERATOR AFC PROVIDER
Credential:
Phone: 507-319-7444