Organization
SHOLOM HOME EAST INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS WYCKOFF (CONTROLLER)
(952) 939-1637
Entity
Organization
Contact information
Practice address
740 KAY AVE, SAINT PAUL, MN 55102-6014
(651) 328-2000
(651) 328-2070
Mailing address
740 KAY AVE, SAINT PAUL, MN 55102-6014
(651) 328-2000
(651) 328-2070
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
328527
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00263
HEALTH PARTNERS
—
05
—
529242500
—
MN
01
—
7100365
MEDICA
—
01
—
7122642
MEDICA
—
01
—
8649SH
BLUE CROSS
—
01
—
NH0089
UCARE
—
Enumeration date
12/28/2005
Last updated
05/14/2019
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