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General NPI Number Information
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NPI Number | 1982214607
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Entity Type | Organization
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Legal Business Name | PARKVIEW MANOR INC
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | 5802 BASS LAKE RD
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City | CRYSTAL
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State | MN
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Zip | 55429-2749
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Country | US
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Telephone | 612-702-7412
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Fax | 612-314-8840
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Provider Business Mailing Address
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Address Line | 10643 WELCOME BAY N
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City | BROOKLYN PARK
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State | MN
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Zip | 55443-3268
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Country | US
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Telephone | 612-702-7412
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Fax | 612-314-8840
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | HELEN A OSONOWO
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Credential | NP
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Telephone | 612-702-7412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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