Basic Information
| Provider Information | |||||||||
| NPI: | 1164478483 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEVERLY ENTERPRISES - MINNESOTA LLC | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | GOLDEN LIVINGCENTER - HOPKINS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 2ND AVE S | ||||||||
| Address2: | |||||||||
| City: | HOPKINS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553437782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529353338 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 725 2ND AVE S | ||||||||
| Address2: | |||||||||
| City: | HOPKINS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553437782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529353338 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 07/16/2014 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RASMUSSEN-JONES | ||||||||
| AuthorizedOfficialFirstName: | HOLLY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 4792014835 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BEVERLY ENTERPRISES - PENNSYLVANIA, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 71-00104 | 01 | MN | MEDICA MEC | OTHER | 245293 | 01 | MN | SECURITY HP | OTHER | 417633200 | 05 | MN | MEDICAID | 5G77HO | 01 | MN | BCBS | OTHER | 88435 | 01 | MN | HEALTH PARTNERS | OTHER | 7111799 | 01 | MN | MEDICA CHOICE | OTHER | NH0028 | 01 | MN | UCARE | OTHER |