MEDICARE: RIVER OAKS HOME HEALTH CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	4579567	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	130913	OTHER	MN	U-CARE INSURANCE
2	2D75RI	OTHER	MN	BC/BS
3	5900088	OTHER	MN	MEDICA INSURANCE

General Provider Information

NPI Number	:	1114920147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER OAKS HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	900 3RD ST
Second Line	:
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-2208
Country	:	US
Telephone Number	:	218-283-3031
Fax Number	:	218-283-4047

Provider Business Practice Location Address
First Line	:	900 3RD ST
Second Line	:
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-2208
Country	:	US
Telephone Number	:	218-283-3031
Fax Number	:	218-283-4047

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. REBECCA LEE LARSEN-GRIFFIN
Credential	:	RN
Telephone Number	:	218-283-3031

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/22/2020

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Directions to “RIVER OAKS HOME HEALTH CARE LLC ” Practice Location

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