Provider Demographics
NPI:1558573592
Name:RIVER SIDE HOME CARE PROVIDER'S, INC
Entity type:Organization
Organization Name:RIVER SIDE HOME CARE PROVIDER'S, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:ADAMO
Authorized Official - Last Name:BEKUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-964-1735
Mailing Address - Street 1:1929 S 5TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1274
Mailing Address - Country:US
Mailing Address - Phone:612-359-9917
Mailing Address - Fax:612-359-9918
Practice Address - Street 1:1929 S 5TH ST STE 201
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1274
Practice Address - Country:US
Practice Address - Phone:612-359-9917
Practice Address - Fax:612-359-9918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health