Organization
AVIV HEALTH CARE, INC.
Active
Other names
BERKSHIRE RESIDENCE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TONY PASELL (COMPTROLLER)
(952) 259-5222
Entity
Organization
Contact information
Practice address
501 2ND ST SE, OSSEO, MN 55369-1603
(763) 425-3939
(763) 424-2777
Mailing address
4509 MINNETONKA BLVD, ST LOUIS PARK, MN 55416-4027
(952) 259-5224
(952) 920-5207
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
328130
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7122708
MEDICA
MN
01
—
9456BE
BLUE CROSS BLUE SHIELD
MN
01
—
NH0003
UCARE
MN
Enumeration date
09/09/2005
Last updated
08/22/2020
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