Provider Demographics
NPI:1811919996
Name:HAMMER RESIDENCES, INC.
Entity type:Organization
Organization Name:HAMMER RESIDENCES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTREM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-277-2422
Mailing Address - Street 1:1909 WAYZATA BOULEVERD
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-2047
Mailing Address - Country:US
Mailing Address - Phone:952-473-1261
Mailing Address - Fax:952-473-8629
Practice Address - Street 1:1909 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-2047
Practice Address - Country:US
Practice Address - Phone:952-473-1261
Practice Address - Fax:952-473-8629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN123345900Medicaid
MN221545400Medicaid
MN318343200Medicaid
MN033045100Medicaid
MN013345100Medicaid
MN656726600Medicaid
MN483545000Medicaid
MN713721400Medicaid