Provider Demographics
NPI:1851516389
Name:DEER RIVER HEALTHCARE CENTER INC.
Entity Type:Organization
Organization Name:DEER RIVER HEALTHCARE CENTER INC.
Other - Org Name:COMMUNITY MEMORIAL HOSPITAL OF DEER RIVER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-246-3047
Mailing Address - Street 1:115 10TH AVENUE NE
Mailing Address - Street 2:
Mailing Address - City:DEER RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:56636-9700
Mailing Address - Country:US
Mailing Address - Phone:218-246-2900
Mailing Address - Fax:218-246-3013
Practice Address - Street 1:115 10TH AVENUE NE
Practice Address - Street 2:
Practice Address - City:DEER RIVER
Practice Address - State:MN
Practice Address - Zip Code:56636-9700
Practice Address - Country:US
Practice Address - Phone:218-246-2900
Practice Address - Fax:218-246-3013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEER RIVER HEALTHCARE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1604HCOOtherBLUE CROSS
MN300367OtherUCARE
MN5025365OtherMEDICA
MN618245300Medicaid
MN1021626OtherPREFERRED ONE
MN24-1360Medicare ID - Type Unspecified
MN618245300Medicaid