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General NPI Number Information
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NPI Number | 1891789434
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Entity Type | Organization
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Legal Business Name | AVIV HEALTH CARE, INC.
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 501 2ND ST SE
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City | OSSEO
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State | MN
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Zip | 55369-1603
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Country | US
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Telephone | 763-425-3939
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Fax | 763-424-2777
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Provider Business Mailing Address
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Address Line | 4509 MINNETONKA BLVD
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-4027
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Country | US
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Telephone | 952-259-5224
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Fax | 952-920-5207
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Authorized Official
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Title or Position | COMPTROLLER
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Name | MR. TONY PASELL
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Credential |
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Telephone | 952-259-5222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 328130
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License Number State | MN
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