1336232057 NPI number — CREST VIEW CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336232057 NPI number — CREST VIEW CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREST VIEW CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336232057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4444 RESERVOIR BLVD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA HEIGHTS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-782-1611
Provider Business Mailing Address Fax Number:
763-782-0857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4444 RESERVOIR BLVD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA HEIGHTS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-782-1611
Provider Business Practice Location Address Fax Number:
763-782-0857
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARNES
Authorized Official First Name:
SHIRLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
763-782-1611

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  330353 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 329319 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 331813 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 970516300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4990027 . This is a "MEDICA CHOICE-ROYCE PLACE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5900019 . This is a "MEDICAL PRIMARY-HOME CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: AL0010 . This is a "U CARE - ROYCE PLACE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5900019 . This is a "MEDICA CHOICE-HOME CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8611CR . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 150220 . This is a "U CARE - HOME CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 7100318 . This is a "MEDICA PRIMARY - NURSING" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 935840400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: NH0134 . This is a "U CARE - NURSING HOME" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4990027 . This is a "MEDICA PRIMARY-ROYCE PLAC" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 7122626 . This is a "MEDICA CHOICE-NURSING HOM" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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