MEDICARE: NORTH CITIES 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	327809	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528053014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CITIES HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	805 6TH AVE NW
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-2717
Country	:	US
Telephone Number	:	651-633-7200
Fax Number	:	651-697-7377

Provider Business Practice Location Address
First Line	:	805 6TH AVE NW
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-2717
Country	:	US
Telephone Number	:	651-633-7200
Fax Number	:	651-697-7377

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHAEL R CHIES
Credential	:
Telephone Number	:	651-633-7200

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	10/21/2009

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