Provider Demographics
NPI:1386192714
Name:RIVER OAKS AT SHADY RIDGE, LLC.
Entity Type:Organization
Organization Name:RIVER OAKS AT SHADY RIDGE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-258-6284
Mailing Address - Street 1:255 SHADY RIDGE RD NW
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-1407
Mailing Address - Country:US
Mailing Address - Phone:763-258-6284
Mailing Address - Fax:
Practice Address - Street 1:255 SHADY RIDGE RD NW
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-1407
Practice Address - Country:US
Practice Address - Phone:763-258-6284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health