1093736431 NPI number — VOA CARE CENTERS, MINNESOTA

Table of content: (NPI 1093736431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093736431 NPI number — VOA CARE CENTERS, MINNESOTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VOA CARE CENTERS, MINNESOTA
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:
1093736431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7485 OFFICE RIDGE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55344-3690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-941-0305
Provider Business Mailing Address Fax Number:
952-941-0428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6200 XERXES AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55423-1033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-925-8500
Provider Business Practice Location Address Fax Number:
952-922-4593
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAVIN
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT SECRETARY/TREASURER
Authorized Official Telephone Number:
952-941-0305

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  330898 , 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: 71-00061 . This is a "MEDICA SENIOR DUAL" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 9647ED . This is a "BCBS NURSING HOME SERVICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 030905002 . This is a "MHP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 89628 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 47243ED . This is a "BCBS PHYSICAL THERAPY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 964043600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: NH0100 . This is a "U-CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 71-11832 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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