NPIMap

Organization Active NPI

State of Minnesota - Minnesota Management and Budget

Doing business as Minnesota Veterans Home - Montevideo

  • Skilled Nursing Facility
  • Montevideo, MN
National Provider Identifier
1407562309
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
STATE OF MINNESOTA - MINNESOTA MANAGEMENT AND BUDGET
Doing business as
Minnesota Veterans Home - Montevideo
Practice address
2190 William Avenue
Montevideo, MN 56265-2273
Phone
(320) 301-0429
Fax
(612) 548-5964
NPI assigned
Jan 25, 2023
Last updated
Dec 3, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF MINNESOTA - MINNESOTA MANAGEMENT AND BUDGETAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Authorized official

Name
Simone Renee Hogan
Title
Mdva Chief Operations Director
Phone
(612) 505-4110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

2190 William Avenue
Montevideo, MN 56265-2273

Mailing address

5101 Minnehaha Ave. S
Minneapolis, MN 55417-1647

Other names 1

  • MINNESOTA VETERANS HOME - MONTEVIDEO Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2294848Minnesota Veterans Home Montevideo2190 William Avenue, Montevideo, MN 56265Certificate of waiverNov 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Dept of Healt28 organizations share this tax ID, including this one
Part of
Minnesota Dept of Healt

Other organizations with this tax ID 27

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

View all 27

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1674604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1407562309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 MINNEHAHA AVE. S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554171647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2190 WILLIAM AVENUE",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "562652273",
            "telephone_number": "320-301-0429",
            "fax_number": "612-548-5964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MINNESOTA - MINNESOTA MANAGEMENT AND BUDGET",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF MINNESOTA - MINNESOTA MANAGEMENT AND BUDGET",
        "enumeration_date": "2023-01-25",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "HOGAN",
        "authorized_official_first_name": "SIMONE",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "MDVA CHIEF OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "612-505-4110"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MINNESOTA VETERANS HOME - MONTEVIDEO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montevideo, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.