Provider Demographics
NPI:1275518714
Name:MORAVIAN CARE HOUSING CORPORATION
Entity Type:Organization
Organization Name:MORAVIAN CARE HOUSING CORPORATION
Other - Org Name:AUBURN HOME IN WACONIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-361-0340
Mailing Address - Street 1:594 CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1405
Mailing Address - Country:US
Mailing Address - Phone:952-442-2546
Mailing Address - Fax:952-442-5504
Practice Address - Street 1:594 CHERRY DR
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1405
Practice Address - Country:US
Practice Address - Phone:952-442-2546
Practice Address - Fax:952-442-5504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORAVIAN CARE MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-07
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327649313M00000X
MN330473314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN211027000Medicaid
MN245583AMedicare ID - Type Unspecified