Organization
SENIOR CARE PROVIDENCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY SUE RICHTER (ACCOUNTANT)
(612) 431-7932
Entity
Organization
Contact information
Practice address
3720 23RD AVE S, MINNEAPOLIS, MN 55407-3010
(612) 724-5495
Mailing address
3720 23RD AVE S, MINNEAPOLIS, MN 55407-3010
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
328868
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
428093639
MHP
MN
05
—
608719100
—
MN
01
—
62845
HPARTNERS
MN
01
—
7100377
MEDICA
MN
01
—
7122705
MEDICA
MN
01
—
8810NI
BCBS
MN
01
—
NH0131
UCARE
MN
Enumeration date
07/10/2007
Last updated
12/27/2022
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