Provider Demographics
NPI:1104236512
Name:EPISCOPAL HOMES ON UNIVERSITY AVENUE, LLC
Entity type:Organization
Organization Name:EPISCOPAL HOMES ON UNIVERSITY AVENUE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-632-8812
Mailing Address - Street 1:1860 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1860 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3402
Practice Address - Country:US
Practice Address - Phone:651-632-8812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPISCOPAL HOME CARE AND SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility