Provider Demographics
NPI:1487910543
Name:DRN ENTERPRISES, INC.
Entity type:Organization
Organization Name:DRN ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:NEWSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-279-6043
Mailing Address - Street 1:205 W 2ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1920
Mailing Address - Country:US
Mailing Address - Phone:218-279-6043
Mailing Address - Fax:218-279-5919
Practice Address - Street 1:205 W 2ND ST STE 200
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1920
Practice Address - Country:US
Practice Address - Phone:218-279-6043
Practice Address - Fax:218-279-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCE000126171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA560672100Medicaid