Provider Demographics
NPI:1629401138
Name:VILLA AT OSSEO LLC
Entity Type:Organization
Organization Name:VILLA AT OSSEO LLC
Other - Org Name:THE VILLA AT OSSEO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:312-521-2467
Mailing Address - Street 1:501 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MN
Mailing Address - Zip Code:55369-1603
Mailing Address - Country:US
Mailing Address - Phone:763-425-3939
Mailing Address - Fax:763-424-2777
Practice Address - Street 1:501 2ND ST SE
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369-1603
Practice Address - Country:US
Practice Address - Phone:763-425-3939
Practice Address - Fax:763-424-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN354043000Medicaid