Organization
PHS MARANATHA INC.
Active
Other names
PHS Maranatha Inc., Maranatha Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARK MEYER (CFO)
(651) 631-6102
Entity
Organization
Contact information
Practice address
5409 69TH AVE N, BROOKLYN CENTER, MN 55429-1505
(763) 549-9600
(763) 549-9636
Mailing address
2845 HAMLINE AVE N, ROSEVILLE, MN 55113-7127
(651) 631-6432
(651) 631-6122
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
328432
MN
314000000X
Skilled Nursing Facility
Primary
328432
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
731342000
—
MN
01
—
NH0032
UCARE
MN
Enumeration date
06/15/2005
Last updated
11/11/2025
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