Provider Demographics
NPI:1134283518
Name:AXIS MINNESOTA, INC.
Entity Type:Organization
Organization Name:AXIS MINNESOTA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHOLLJEGERDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-774-5940
Mailing Address - Street 1:2345 RICE ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3741
Mailing Address - Country:US
Mailing Address - Phone:651-774-5940
Mailing Address - Fax:651-774-8126
Practice Address - Street 1:1586 SENECA TRL
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55110-5882
Practice Address - Country:US
Practice Address - Phone:651-774-5940
Practice Address - Fax:651-774-8126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1038653-1-RS315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities