Provider Demographics
NPI:1043700073
Name:EVANS PARK, INC
Entity Type:Organization
Organization Name:EVANS PARK, INC
Other - Org Name:ENGEL HAUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CFO
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-241-4445
Mailing Address - Street 1:508 FREEPORT AVE NW STE A
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1874
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5101 KASSEL AVE
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55301-4735
Practice Address - Country:US
Practice Address - Phone:763-498-4594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVANS PARK, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA974660300OtherMINNESOTA DEPARTMENT OF HUMAN SERVICES