St. Olaf Residence, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

00260 Issued in MN

Legal business name

ST. OLAF RESIDENCE, INC.

Practice address

2912 Fremont Ave N
Minneapolis, MN 55411-1313

Phone

(612) 522-6561

Fax

(612) 522-2921

NPI assigned

Jun 21, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Timothy Meyer

Title

Administrator

Phone

(612) 287-3538

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255337796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2912 FREMONT AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554111313",
            "telephone_number": "612-522-6561",
            "fax_number": "612-522-2921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2912 FREMONT AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554111313",
            "telephone_number": "612-522-6561",
            "fax_number": "612-522-2921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. OLAF RESIDENCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "612-287-3538",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "00260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.