Provider Demographics
NPI:1104216837
Name:RIVER CITY TRAIL D/B/A CARING MATTERS HOME CARE
Entity Type:Organization
Organization Name:RIVER CITY TRAIL D/B/A CARING MATTERS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEZURIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-445-9199
Mailing Address - Street 1:10040 UNION TERRACE LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-3441
Mailing Address - Country:US
Mailing Address - Phone:763-445-9199
Mailing Address - Fax:
Practice Address - Street 1:10040 UNION TERRACE LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-3441
Practice Address - Country:US
Practice Address - Phone:763-445-9199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN371615253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care