Provider Demographics
NPI:1902988868
Name:RICE COUNTY DISTRICT ONE HOSPITAL
Entity Type:Organization
Organization Name:RICE COUNTY DISTRICT ONE HOSPITAL
Other - Org Name:FARIBAULT AREA HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ALOIS
Authorized Official - Last Name:JUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:507-332-4731
Mailing Address - Street 1:200 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-6339
Mailing Address - Country:US
Mailing Address - Phone:507-334-6451
Mailing Address - Fax:507-332-4848
Practice Address - Street 1:200 STATE AVE
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-6339
Practice Address - Country:US
Practice Address - Phone:507-334-6451
Practice Address - Fax:507-332-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328122315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN241532Medicare ID - Type Unspecified