Provider Demographics
NPI:1891789434
Name:AVIV HEALTH CARE, INC.
Entity Type:Organization
Organization Name:AVIV HEALTH CARE, INC.
Other - Org Name:BERKSHIRE RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PASELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-259-5222
Mailing Address - Street 1:4509 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4027
Mailing Address - Country:US
Mailing Address - Phone:952-259-5224
Mailing Address - Fax:952-920-5207
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:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328130313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7122708OtherMEDICA
MN9456BEOtherBLUE CROSS BLUE SHIELD
MNNH0003OtherUCARE