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Organization
GRAND AVENUE REST HOME INC
Active
Organization
GRAND AVENUE REST HOME INC
Active
Other names
Grand Avenue Residence
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANCY LYNN SODERBECK (ACTING ADMINISTRATOR)
(612) 824-1434
Entity
Organization
Contact information
Practice address
3956 GRAND AVE S, MINNEAPOLIS, MN 55409-1535
(612) 824-1434
(612) 824-2219
Mailing address
3956 GRAND AVE S, MINNEAPOLIS, MN 55409-1535
(612) 824-1434
(612) 824-2219
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
—
MN
Other
Enumeration date
10/01/2005
Last updated
08/22/2020
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