Provider Demographics
NPI:1730421249
Name:RIVERFRONT MANOR
Entity type:Organization
Organization Name:RIVERFRONT MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRITY
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:218-863-2991
Mailing Address - Street 1:215 E MILL AVE
Mailing Address - Street 2:
Mailing Address - City:PELICAN RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56572-4250
Mailing Address - Country:US
Mailing Address - Phone:218-863-1133
Mailing Address - Fax:
Practice Address - Street 1:215 E MILL AVE
Practice Address - Street 2:
Practice Address - City:PELICAN RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56572-4250
Practice Address - Country:US
Practice Address - Phone:218-863-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PELICAN VALLEY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN357561310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1801819636OtherNPI