Provider Demographics
NPI:1497912224
Name:DECKER'S FAMILY CARE, INC.
Entity Type:Organization
Organization Name:DECKER'S FAMILY CARE, INC.
Other - Org Name:RANIER ROOST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:218-286-5635
Mailing Address - Street 1:3443 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:RANIER
Mailing Address - State:MN
Mailing Address - Zip Code:56668
Mailing Address - Country:US
Mailing Address - Phone:218-286-5635
Mailing Address - Fax:218-286-5312
Practice Address - Street 1:3443 PINE ST.
Practice Address - Street 2:
Practice Address - City:RANIER
Practice Address - State:MN
Practice Address - Zip Code:56668
Practice Address - Country:US
Practice Address - Phone:218-286-5635
Practice Address - Fax:218-286-5312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN690956600310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN690956600OtherMN-ITS