Provider Demographics
NPI:1205077559
Name:VSSA CARE CENTER LLC
Entity type:Organization
Organization Name:VSSA CARE CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-631-6120
Mailing Address - Street 1:13575 58TH ST. N.
Mailing Address - Street 2:
Mailing Address - City:OAK PARK HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6994
Mailing Address - Country:US
Mailing Address - Phone:651-430-7200
Mailing Address - Fax:651-430-7201
Practice Address - Street 1:13575 58TH ST. N.
Practice Address - Street 2:
Practice Address - City:OAK PARK HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55082-6994
Practice Address - Country:US
Practice Address - Phone:651-430-7200
Practice Address - Fax:651-430-7201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY SENIOR SERVICES ALLIANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-17
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343663314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN378150100Medicaid
MNNH0827OtherUCARE
MNNH0827OtherUCARE
MN245615Medicare UPIN