Healthcare Provider Details

I. General information

NPI: 1073431532
Provider Name (Legal Business Name): STATE OF MN RECEIVERSHIP - TERRACE CRYSTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 VERA CRUZ AVE N
CRYSTAL MN
55422-2708
US

IV. Provider business mailing address

11240 STILLWATER BLVD N
LAKE ELMO MN
55042-9321
US

V. Phone/Fax

Practice location:
  • Phone: 763-971-6300
  • Fax:
Mailing address:
  • Phone: 651-407-8699
  • Fax:

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: PETER B SCHUNA
Title or Position: MANAGING AGENT
Credential:
Phone: 651-407-8699