Healthcare Provider Details

I. General information

NPI: 1528053014
Provider Name (Legal Business Name): NORTH CITIES HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 6TH AVE NW
NEW BRIGHTON MN
55112-2717
US

IV. Provider business mailing address

805 6TH AVE NW
NEW BRIGHTON MN
55112-2717
US

V. Phone/Fax

Practice location:
  • Phone: 651-633-7200
  • Fax: 651-697-7377
Mailing address:
  • Phone: 651-633-7200
  • Fax: 651-697-7377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number327809
License Number StateMN

VIII. Authorized Official

Name: MICHAEL R CHIES
Title or Position: ADMINISTRATOR
Credential:
Phone: 651-633-7200