Provider Demographics
NPI:1568456234
Name:SOUTHVIEW ACRES HEALTH CARE CENTER INC
Entity Type:Organization
Organization Name:SOUTHVIEW ACRES HEALTH CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-260-5435
Mailing Address - Street 1:2000 OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-4662
Mailing Address - Country:US
Mailing Address - Phone:651-451-1821
Mailing Address - Fax:651-451-9538
Practice Address - Street 1:2000 OAKDALE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-4662
Practice Address - Country:US
Practice Address - Phone:651-451-1821
Practice Address - Fax:651-451-9538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327171314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN798240200Medicaid
MN798240200Medicaid