Provider Demographics
NPI:1912935883
Name:GRANDVIEW CHRISTIAN HOME
Entity Type:Organization
Organization Name:GRANDVIEW CHRISTIAN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-631-6120
Mailing Address - Street 1:322 RIVER HILLS PL
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-3759
Mailing Address - Country:US
Mailing Address - Phone:763-691-6200
Mailing Address - Fax:
Practice Address - Street 1:135 FERN ST N
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1033
Practice Address - Country:US
Practice Address - Phone:763-689-1474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00294314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9742GROtherBLUE CROSS BLUE SHIELD
MN7122543OtherMEDICA
MN893042200Medicaid
MNNH0368OtherUCARE
MN245432Medicare Oscar/Certification