Provider Demographics
NPI:1982600482
Name:EPISCOPAL CHRCH HOME OF MINNESOTA
Entity Type:Organization
Organization Name:EPISCOPAL CHRCH HOME OF MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KAREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-632-8812
Mailing Address - Street 1:1879 FERONIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3549
Mailing Address - Country:US
Mailing Address - Phone:651-632-8817
Mailing Address - Fax:651-632-8806
Practice Address - Street 1:1879 FERONIA AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3549
Practice Address - Country:US
Practice Address - Phone:651-632-8817
Practice Address - Fax:651-632-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328690313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245452Medicare ID - Type Unspecified