Provider Demographics
NPI:1750467577
Name:OUR HOUSE OF MINNESOTA, INC. I
Entity Type:Organization
Organization Name:OUR HOUSE OF MINNESOTA, INC. I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-646-1104
Mailing Address - Street 1:1846 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6062
Mailing Address - Country:US
Mailing Address - Phone:651-646-1104
Mailing Address - Fax:651-646-1104
Practice Address - Street 1:1846 DAYTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6012
Practice Address - Country:US
Practice Address - Phone:651-644-6650
Practice Address - Fax:651-644-6650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN801828-1-RS315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities