Basic Information
| Provider Information | |||||||||
| NPI: | 1437192275 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. ANTHONY NURSING HOME LIMITED PARTNERSHIP | ||||||||
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| OtherOrganizationName: | ST. ANTHONY HEALTH & REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1107 HAZELTINE BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHASKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553181009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9523618000 | ||||||||
| FaxNumber: | 9523618058 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 FOSS RD | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554214512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6129135304 | ||||||||
| FaxNumber: | 6127880104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 02/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | WEICHERT | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 9523618000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 329079 | MN | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 314000000X | 328175 | MN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 8666AN | 01 | MN | BCBS | OTHER | 266 | 01 | MN | HEALTH PARTNERS | OTHER | 369742800 | 05 | MN | MEDICAID | 71-11817 | 01 | MN | MEDICA/FAIRVIEW PARTNERS | OTHER | 620063000 | 01 | MN | ELDER WAIVER | OTHER | NH0090 | 01 | MN | UCARE/FAIRVIEW PARTNERS | OTHER | 71-00060 | 01 | MN | MEDICA | OTHER |