=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932479482
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CV SENIOR HOUSING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2011
-----------------------------------------------------
Last Update Date | 11/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 FAIRVIEW AVE S
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55116-1458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-631-5000
-----------------------------------------------------
Fax | 651-631-5001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2845 HAMLINE AVE N
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55113-7127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-631-6432
-----------------------------------------------------
Fax | 651-631-6122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. MARK T MEYER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-631-6102
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 27189
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------