=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851059976
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN VOLUNTEERS HOMES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2021
-----------------------------------------------------
Last Update Date | 12/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5202 QUAIL AVE N
-----------------------------------------------------
City | CRYSTAL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55429-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-710-9696
-----------------------------------------------------
Fax | 763-201-5822
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5202 QUAIL AVE N
-----------------------------------------------------
City | CRYSTAL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55429-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-710-9696
-----------------------------------------------------
Fax | 763-201-5822
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | FLOYD PRINCE GEORGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 763-210-8532
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------