NPIMap

Organization Active NPI

Axis Minnesota, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Roseville, MN
National Provider Identifier
1053475434
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
1030626-1-RS Issued in MN
Legal business name
AXIS MINNESOTA, INC.
Practice address
692 Belmont LN W
Roseville, MN 55113-6470
Phone
(651) 774-5940
Fax
(651) 774-8126
NPI assigned
Dec 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Denise Marie Scholljegerdes
Title
Cfo
Phone
(651) 774-5940

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 1030626-1-RS MN Primary

Addresses

Primary practice location

692 Belmont LN W
Roseville, MN 55113-6470

Mailing address

2345 Rice St
Suite 112
Roseville, MN 55113-3741
Phone (651) 774-5940

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 24G507

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
AXIS ON BELMONT
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Aug 6, 2004
Last certification
Nov 27, 2024
Beds
4
Ownership / control type
Private (proprietary)
Facility address
692 Belmont Lane West
Roseville, MN 55113

National Provider Directory

National Provider Directory
Tax ID family
Axis Minnesota Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2345 Rice St
Ste 112
Roseville, MN 55113
Phone (651) 357-1100

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053475434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 RICE ST",
            "address_2": "SUITE 112",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133741",
            "telephone_number": "651-774-5940",
            "fax_number": "651-774-8126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "692 BELMONT LN W",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551136470",
            "telephone_number": "651-774-5940",
            "fax_number": "651-774-8126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXIS MINNESOTA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHOLLJEGERDES",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "651-774-5940"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MN",
            "license": "1030626-1-RS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MN

Sources for this page

Verify at the official NPI Registry.