MEDICARE: VALLEY VIEW NURSING HOME OF HOUSTON, 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	328214	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	306GVA	OTHER	MN	BLUE PLUS
2	140012	OTHER	MN	UCARE

General Provider Information

NPI Number	:	1568465607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY VIEW NURSING HOME OF HOUSTON, INC.

Provider Business Mailing Address
First Line	:	510 E CEDAR ST
Second Line	:
City	:	HOUSTON
State	:	MN
Zip	:	55943-8618
Country	:	US
Telephone Number	:	507-896-3125
Fax Number	:	507-896-3289

Provider Business Practice Location Address
First Line	:	510 E CEDAR ST
Second Line	:
City	:	HOUSTON
State	:	MN
Zip	:	55943-8618
Country	:	US
Telephone Number	:	507-896-3125
Fax Number	:	507-896-3289

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	THOMAS LINDH
Credential	:
Telephone Number	:	507-896-3125

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/22/2020

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