Healthcare Provider Details

I. General information

NPI: 1114547395
Provider Name (Legal Business Name): BVM-PHS SENIOR HOUSING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 CARMEL DR
DUBUQUE IA
52003-7984
US

IV. Provider business mailing address

2845 HAMLINE AVE N
ROSEVILLE MN
55113-7127
US

V. Phone/Fax

Practice location:
  • Phone: 651-631-6432
  • Fax: 651-631-6122
Mailing address:
  • Phone: 651-631-6432
  • Fax: 651-631-6122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MARK MEYER
Title or Position: CFO
Credential:
Phone: 651-631-6102