Provider Demographics
NPI:1326069642
Name:THE HOMESTEAD AT ANOKA, INC.
Entity Type:Organization
Organization Name:THE HOMESTEAD AT ANOKA, INC.
Other - Org Name:ANOKA REHABILITATION AND LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-428-7840
Mailing Address - Street 1:7485 OFFICE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3690
Mailing Address - Country:US
Mailing Address - Phone:952-941-0305
Mailing Address - Fax:952-941-0428
Practice Address - Street 1:3000 4TH AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1203
Practice Address - Country:US
Practice Address - Phone:763-528-6400
Practice Address - Fax:763-528-6479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330543314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7111783OtherMEDICA
MN6C77ANOtherBCBS
MN261960100Medicaid
MN92334OtherHP
MNNH0132OtherU-CARE
MN245205Medicare Oscar/Certification