MEDICARE: PARK RIVER HEALTHCARE AND REHABILITATION CENTER 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1700755337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK RIVER HEALTHCARE AND REHABILITATION CENTER LLC

Provider Business Mailing Address
First Line	:	9899 AVOCET ST NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-6413
Country	:	US
Telephone Number	:	763-757-2320
Fax Number	:

Provider Business Practice Location Address
First Line	:	9899 AVOCET ST NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-6413
Country	:	US
Telephone Number	:	763-757-2320
Fax Number	:

Authorized Official
Title or Position	:	CONSULTANT
Name	:	REUBEN KNOBEL
Credential	:
Telephone Number	:	516-940-5100

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	03/02/2026

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