NPIMap

Organization Active NPI

Axis Minnesota, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Shoreview, MN
National Provider Identifier
1487745626
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
1028084-1-RS Issued in MN
Legal business name
AXIS MINNESOTA, INC.
Practice address
1083 Glenhill Rd
Shoreview, MN 55126-8115
Phone
(651) 774-5940
NPI assigned
Sep 27, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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 1028084-1-RS MN Primary

Addresses

Primary practice location

1083 Glenhill Rd
Shoreview, MN 55126-8115

Mailing address

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

Medicare participation

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487745626. Details of each certification follow.

  • CCN 24G504 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 24G504

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 GLENHILL
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jan 26, 2004
Last certification
Feb 5, 2025
Beds
4
Ownership / control type
Private (proprietary)
Facility address
1083 Glenhill Road
Shoreview, MN 55126

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.

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487745626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 RICE STREET",
            "address_2": "SUITE 112",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "55113",
            "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": "1083 GLENHILL RD",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551268115",
            "telephone_number": "651-774-5940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXIS MINNESOTA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "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": "1028084-1-RS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreview, MN

Sources for this page

Verify at the official NPI Registry.