Healthcare Provider Details

I. General information

NPI: 1104236512
Provider Name (Legal Business Name): EPISCOPAL HOMES ON UNIVERSITY AVENUE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 UNIVERSITY AVE W
SAINT PAUL MN
55104-3402
US

IV. Provider business mailing address

1860 UNIVERSITY AVE W
SAINT PAUL MN
55104-3402
US

V. Phone/Fax

Practice location:
  • Phone: 651-632-8812
  • Fax:
Mailing address:
  • Phone:
  • 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: MIKE KAREL
Title or Position: COO
Credential:
Phone: 651-632-8812