Basic Information
| Provider Information | |||||||||
| NPI: | 1336133990 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AVIV HEALTH CARE, INC. | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | WESTWOOD HEALTH CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4509 MINNETONKA BLVD | ||||||||
| Address2: | |||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554164027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9522595224 | ||||||||
| FaxNumber: | 9529205207 | ||||||||
| Practice Location | |||||||||
| Address1: | 7500 W 22ND ST | ||||||||
| Address2: | |||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554262602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525464261 | ||||||||
| FaxNumber: | 9525467164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 04/10/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PASELL | ||||||||
| AuthorizedOfficialFirstName: | TONY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | COMPTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 9522595222 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 327080 | MN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 301134800 | 01 | MN | MHP | OTHER | 309820600 | 05 | MN | MEDICAID | 32314 | 01 | MN | HEALTH PARTNERS | OTHER | 7122486 | 01 | MN | MEDICA | OTHER | NH0064 | 01 | MN | UCARE | OTHER | 7100165 | 01 | MN | MEDICA | OTHER | 8695WE | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER |