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General NPI Number Information
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NPI Number | 1952643843
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Entity Type | Organization
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Legal Business Name | RUM RIVER HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 1506 1ST ST
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City | PRINCETON
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State | MN
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Zip | 55371-1462
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Country | US
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Telephone | 763-389-5080
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Fax | 763-389-5453
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Provider Business Mailing Address
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Address Line | 101 18TH AVE N
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City | PRINCETON
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State | MN
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Zip | 55371-4756
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Country | US
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Telephone | 763-389-5080
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Fax | 763-631-9117
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JEFFREY DONALD LARSON
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Credential |
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Telephone | 763-389-5080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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