Provider Demographics
NPI:1154419422
Name:RICH'S EOT HOMES INC.
Entity type:Organization
Organization Name:RICH'S EOT HOMES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:KEMPENICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-346-3960
Mailing Address - Street 1:445 3RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573-1510
Mailing Address - Country:US
Mailing Address - Phone:218-346-3960
Mailing Address - Fax:218-346-7922
Practice Address - Street 1:445 3RD AVE NE
Practice Address - Street 2:
Practice Address - City:PERHAM
Practice Address - State:MN
Practice Address - Zip Code:56573-1510
Practice Address - Country:US
Practice Address - Phone:218-346-3960
Practice Address - Fax:218-346-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1021007320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1021007OtherMN FOSTER CARE 245-B