Healthcare Provider Details

I. General information

NPI: 1700204450
Provider Name (Legal Business Name): GVP SENIOR CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WHITE BEAR AVE N
SAINT PAUL MN
55106-1608
US

IV. Provider business mailing address

1600 WHITE BEAR AVE N
SAINT PAUL MN
55106-1608
US

V. Phone/Fax

Practice location:
  • Phone: 651-444-8183
  • Fax: 651-444-8182
Mailing address:
  • Phone: 651-444-8183
  • Fax: 651-444-8182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1066212-1-ADC
License Number StateMN

VIII. Authorized Official

Name: MR. TOUNEY T XIONG
Title or Position: PRESIDENT
Credential:
Phone: 651-444-8183