Healthcare Provider Details

I. General information

NPI: 1952643843
Provider Name (Legal Business Name): RUM RIVER HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 1ST ST
PRINCETON MN
55371-1462
US

IV. Provider business mailing address

101 18TH AVE N
PRINCETON MN
55371-4756
US

V. Phone/Fax

Practice location:
  • Phone: 763-389-5080
  • Fax: 763-389-5453
Mailing address:
  • Phone: 763-389-5080
  • Fax: 763-631-9117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY DONALD LARSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 763-389-5080