Provider Demographics
NPI:1114920147
Name:RIVER OAKS HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:RIVER OAKS HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LARSEN-GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:218-283-3031
Mailing Address - Street 1:900 3RD ST
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-2208
Mailing Address - Country:US
Mailing Address - Phone:218-283-3031
Mailing Address - Fax:218-283-4047
Practice Address - Street 1:900 3RD ST
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2208
Practice Address - Country:US
Practice Address - Phone:218-283-3031
Practice Address - Fax:218-283-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4579567251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN130913OtherU-CARE INSURANCE
MN2D75RIOtherBC/BS
MN5900088OtherMEDICA INSURANCE
MN5900088OtherMEDICA INSURANCE