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NPI Code Detail

MEDICARE: JONES HARRISON RESIDENCE CORPORATION

MEDICARE: JONES HARRISON RESIDENCE CORPORATION
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
1251E00000XHome Health Agency329866MN
2310400000XAssisted Living FacilityL14827307MN
3314000000XSkilled Nursing Facility328173MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
27122738OTHERMEDICA
39626TOOTHERBCBS

General Provider Information

NPI Number : 1699762195
Entity Type Code : Organization
Provider Name (Legal Business Name) : JONES HARRISON RESIDENCE CORPORATION
Provider Business Mailing Address
First Line : 3700 CEDAR LAKE AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55416-4240
Country : US
Telephone Number : 612-920-2030
Fax Number : 612-920-2824
Provider Business Practice Location Address
First Line : 3700 CEDAR LAKE AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55416-4240
Country : US
Telephone Number : 612-920-2030
Fax Number : 612-920-2824
Authorized Official
Title or Position : PRESIDENT/CEO
Name : ANNETTE GREELY
Credential :
Telephone Number : 612-920-2030
Provider Enumeration Date : 09/30/2005
Last Update Date : 06/02/2022

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