Provider Demographics
NPI:1659430338
Name:MINNETONKA HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:MINNETONKA HEALTH CARE CENTER, INC.
Other - Org Name:LAKE MINNETONKA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SPRINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:JD, MDIV
Authorized Official - Phone:952-474-4474
Mailing Address - Street 1:20395 SUMMERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-9226
Mailing Address - Country:US
Mailing Address - Phone:952-474-4474
Mailing Address - Fax:952-474-4272
Practice Address - Street 1:20395 SUMMERVILLE RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-9226
Practice Address - Country:US
Practice Address - Phone:952-474-4474
Practice Address - Fax:952-474-4272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330780314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245606Medicare ID - Type Unspecified