Provider Demographics
NPI:1013040112
Name:PRESBYTERIAN HOMES OF NORTH OAKS INC,
Entity Type:Organization
Organization Name:PRESBYTERIAN HOMES OF NORTH OAKS INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-631-6450
Mailing Address - Street 1:5919 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-6821
Mailing Address - Country:US
Mailing Address - Phone:651-631-6450
Mailing Address - Fax:651-631-6122
Practice Address - Street 1:5919 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-6821
Practice Address - Country:US
Practice Address - Phone:651-765-4000
Practice Address - Fax:651-765-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNH0581OtherUCARE
MN836967000Medicaid
7100507OtherMEDICA