1336232057 NPI number — CREST VIEW CORPORATION

Table of content: (NPI 1336232057)

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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