Provider Demographics
NPI:1710011234
Name:REHOBOTH DISABLED & ELDERLY FOSTER CARE LLC
Entity Type:Organization
Organization Name:REHOBOTH DISABLED & ELDERLY FOSTER CARE LLC
Other - Org Name:REHOBOTH L
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER,OPERATOR AFC PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANN
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:SCHRIMPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-319-7444
Mailing Address - Street 1:3696 110TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ORONOCO
Mailing Address - State:MN
Mailing Address - Zip Code:55960-2147
Mailing Address - Country:US
Mailing Address - Phone:507-319-7444
Mailing Address - Fax:507-367-2829
Practice Address - Street 1:3696 110TH ST NW
Practice Address - Street 2:
Practice Address - City:ORONOCO
Practice Address - State:MN
Practice Address - Zip Code:55960-2147
Practice Address - Country:US
Practice Address - Phone:507-319-7444
Practice Address - Fax:507-367-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1005701-2-AFC311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN976472100OtherADULT FOSTER CARE
MN702654400OtherADULT FOSTER CARE
MN373487100OtherADULT FOSTER CARE