Provider Demographics
NPI:1992866032
Name:VOA CARE CENTERS, MINNESOTA
Entity Type:Organization
Organization Name:VOA CARE CENTERS, MINNESOTA
Other - Org Name:MAPLEWOOD CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-941-0305
Mailing Address - Street 1:7485 OFFICE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3690
Mailing Address - Country:US
Mailing Address - Phone:952-941-0305
Mailing Address - Fax:952-941-0428
Practice Address - Street 1:1900 SHERREN AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-2803
Practice Address - Country:US
Practice Address - Phone:651-770-1365
Practice Address - Fax:651-770-1646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330192314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN60092OtherHEALTH PARTNERS
MN8735MAOtherBCBS AND BLUE PLUS
MNNH0081OtherUCARE AND EVERCARE UCARE
MN010343800Medicaid
MN71-00059OtherMEDICA DUAL SOLUTIONS
MN71-11833OtherMEDICA