Provider Demographics
NPI:1336232057
Name:CREST VIEW CORPORATION
Entity Type:Organization
Organization Name:CREST VIEW CORPORATION
Other - Org Name:CV LUTHERAN HOME, BLVD APTS, ROYCE PLACE, CV HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-782-1611
Mailing Address - Street 1:4444 RESERVOIR BLVD NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421
Mailing Address - Country:US
Mailing Address - Phone:763-782-1611
Mailing Address - Fax:763-782-0857
Practice Address - Street 1:4444 RESERVOIR BLVD NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421
Practice Address - Country:US
Practice Address - Phone:763-782-1611
Practice Address - Fax:763-782-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330353251E00000X
MN329319310400000X
MN331813314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN970516300Medicaid
MN4990027OtherMEDICA CHOICE-ROYCE PLACE
MN5900019OtherMEDICAL PRIMARY-HOME CARE
MNAL0010OtherU CARE - ROYCE PLACE
MN5900019OtherMEDICA CHOICE-HOME CARE
MN8611CROtherBLUE CROSS/BLUE SHIELD
MN150220OtherU CARE - HOME CARE
MN7100318OtherMEDICA PRIMARY - NURSING
MN935840400Medicaid
MNNH0134OtherU CARE - NURSING HOME
MN4990027OtherMEDICA PRIMARY-ROYCE PLAC
MN7122626OtherMEDICA CHOICE-NURSING HOM
MNNH0134OtherU CARE - NURSING HOME