Provider Demographics
NPI:1235124231
Name:AVIV HEALTH CARE, INC.
Entity Type:Organization
Organization Name:AVIV HEALTH CARE, INC.
Other - Org Name:BRYN MAWR HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PASELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-259-5222
Mailing Address - Street 1:4509 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4027
Mailing Address - Country:US
Mailing Address - Phone:952-259-5224
Mailing Address - Fax:952-920-5207
Practice Address - Street 1:275 PENN AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-1216
Practice Address - Country:US
Practice Address - Phone:612-377-4723
Practice Address - Fax:612-377-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327079314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30329Medicaid
MN7122599OtherMEDICA
MN7100254OtherMEDICA
MN8711BROtherBLUE CROSS BLUE SHIELD
MNNH0006OtherUCARE
MN8711BROtherBLUE CROSS BLUE SHIELD