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
1	314000000X	Skilled Nursing Facility	327080	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	301134800	OTHER	MN	MHP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	32314	OTHER	MN	HEALTH PARTNERS
4	7122486	OTHER	MN	MEDICA
5	NH0064	OTHER	MN	UCARE
6	7100165	OTHER	MN	MEDICA
7	8695WE	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1336133990
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	:	7500 W 22ND ST
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-2602
Country	:	US
Telephone Number	:	952-546-4261
Fax Number	:	952-546-7164

Authorized Official
Title or Position	:	COMPTROLLER
Name	:	MR. TONY PASELL
Credential	:
Telephone Number	:	952-259-5222

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	04/10/2013

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