1699762195 NPI number — JONES HARRISON RESIDENCE CORPORATION

Table of content: (NPI 1699762195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699762195 NPI number — JONES HARRISON RESIDENCE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONES HARRISON RESIDENCE 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:
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:
1699762195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 CEDAR LAKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55416-4240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-920-2030
Provider Business Mailing Address Fax Number:
612-920-2824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 CEDAR LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55416-4240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-920-2030
Provider Business Practice Location Address Fax Number:
612-920-2824
Provider Enumeration Date:
09/30/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GREELY
Authorized Official First Name:
ANNETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
612-920-2030

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  329866 , 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: L14827307 , 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: 328173 , 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: 461242600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7122738 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9626TO . This is a "BCBS" identifier . This identifiers is of the category "OTHER".