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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