Provider Demographics
NPI:1336133990
Name:AVIV HEALTH CARE, INC.
Entity Type:Organization
Organization Name:AVIV HEALTH CARE, INC.
Other - Org Name:WESTWOOD 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 1:7500 W 22ND ST
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-2602
Practice Address - Country:US
Practice Address - Phone:952-546-4261
Practice Address - Fax:952-546-7164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327080314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN301134800OtherMHP
MN309820600Medicaid
MN32314OtherHEALTH PARTNERS
MN7122486OtherMEDICA
MNNH0064OtherUCARE
MN7100165OtherMEDICA
MN8695WEOtherBLUE CROSS BLUE SHIELD
MN245182AMedicare ID - Type UnspecifiedMEDICARE