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NPI Code Detail

MEDICARE: AVIV HEALTH CARE, INC.

MEDICARE: AVIV HEALTH CARE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility327079MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
27122599OTHERMNMEDICA
37100254OTHERMNMEDICA
48711BROTHERMNBLUE CROSS BLUE SHIELD
5NH0006OTHERMNUCARE

General Provider Information

NPI Number : 1235124231
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVIV HEALTH CARE, INC.
Provider Business Mailing Address
First Line : 4509 MINNETONKA BLVD
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-4027
Country : US
Telephone Number : 952-259-5224
Fax Number : 952-920-5207
Provider Business Practice Location Address
First Line : 275 PENN AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55405-1216
Country : US
Telephone Number : 612-377-4723
Fax Number : 612-377-0294
Authorized Official
Title or Position : COMPTROLLER
Name : MR. TONY PASELL
Credential :
Telephone Number : 952-259-5222
Provider Enumeration Date : 09/15/2005
Last Update Date : 08/22/2020

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