Provider Demographics
NPI:1568735090
Name:STATE OF MINNESOTA-MINNESOTA MANAGEMENT AND BUDGET
Entity Type:Organization
Organization Name:STATE OF MINNESOTA-MINNESOTA MANAGEMENT AND BUDGET
Other - Org Name:MINNESOTA VETERANS HOME - LUVERNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-317-3198
Mailing Address - Street 1:5101 MINNEHAHA AVE BLDG 10
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1647
Mailing Address - Country:US
Mailing Address - Phone:612-548-5962
Mailing Address - Fax:612-548-5964
Practice Address - Street 1:1300 N KNISS AVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:MN
Practice Address - Zip Code:56156-1006
Practice Address - Country:US
Practice Address - Phone:507-283-6200
Practice Address - Fax:507-283-1127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINNESOTA MANAGEMENT AND BUDGET
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-14
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN354673314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility