Organization
SHOLOM HOME WEST INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS WYCKOFF (CONTROLLER)
(952) 939-1637
Entity
Organization
Contact information
Practice address
3620 PHILLIPS PKWY, ST LOUIS PARK, MN 55426-3700
(952) 935-6311
(952) 935-2701
Mailing address
3620 PHILLIPS PKWY, ST LOUIS PARK, MN 55426-3700
(952) 935-6311
(952) 935-2701
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
328688
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000320420
HIGHMARK
—
05
—
151743100
—
MN
01
—
23377
HEALTH PARTNERS
MN
05
—
30425
—
ND
01
—
4553SH
BLUE CROSS OF MINNESOTA
MN
01
—
7100366
EVERCARE
MN
01
—
7122633
MEDICA
MN
01
—
971216005
METRA HEALTH
MN
01
—
NH0048
UCARE
MN
Enumeration date
12/28/2005
Last updated
05/14/2019
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