NPIMap

Organization Active NPI

State of Minnesota-Minnesota Management and Budget

Doing business as Minnesota Veterans Home - Pharmacy

  • Long Term Care Pharmacy
  • Minneapolis, MN
National Provider Identifier
1891021390
Registry record updated Mar 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
STATE OF MINNESOTA-MINNESOTA MANAGEMENT AND BUDGET
Doing business as
Minnesota Veterans Home - Pharmacy
Minnesota Veterans Home Pharmacy
Practice address
5101 Minnehaha Ave
Minneapolis, MN 55417-1647
Phone
(612) 548-5930
Fax
(612) 548-5935
NPI assigned
Oct 19, 2009
Last updated
Mar 19, 2019By 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 Mar 19, 2019

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

Authorized official

Name
Mary Elizabeth Johnson
Title
Central Pharmacy, Pharmacist Senior
Phone
(612) 548-5962

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X 201261 MN
Long Term Care Pharmacy 3336L0003X NU Primary

Addresses

Primary practice location

5101 Minnehaha Ave
Minneapolis, MN 55417-1647

Mailing address

5101 Minnehaha Ave BLDG 10
Minneapolis, MN 55417-1647
Phone (612) 548-5930

Other identifiers 1

IdentifierTypeStateIssuer
2413499OtherNCPDP

Other names 2

  • Minnesota Veterans Home - Pharmacy Doing business as
  • Minnesota Veterans Home Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171212002392 MN Part B Supplier - Pharmacy 1658268677 Practice locations: Minneapolis, MN

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
St Cloud State Univ HLT28 organizations share this tax ID, including this one
Part of
St Cloud State Univ HLT

Other organizations with this tax ID 27

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

View all 27

Locations

5101 Minnehaha Ave
Bldg 15
Minneapolis, MN 55417
Phone (612) 548-5930

20 12th St W
Ste 200
Saint Paul, MN 55155

Ownership & related parties

All facility ownership & control disclosures 12

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community Behavioral Health Hospital-Fergus FallsFergus Falls, MN, CCN 244013 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 26, 2006
Community Behavioral Health Hospital-AnnandaleAnnandale, MN, CCN 244011 Hospital 5% Or Greater Direct Ownership Interest Aug 8, 2006
CBHH BaxterBaxter, MN, CCN 244015 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 17, 2007
Anoka Metro Regional Treatment CenterAnoka, MN, CCN 244002 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 11, 2008
Community Behavioral Health Hospital BemidjiBemidji, MN, CCN 244014 Hospital 5% Or Greater Direct Ownership Interest (100%) Mar 8, 2007
CBHH - RochesterRochester, MN, CCN 244017 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 14, 2006
Child & Adolescent Behavioral Health ServicesWillmar, MN, CCN 244005 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Minnesota Veterans Home - Silver BaySilver Bay, MN, CCN 245628 Skilled nursing facility Operational/Managerial Control (100%) Jul 28, 2008
Interim Healthcare of Treasure Coast, Inc.West Palm Beach, FL, CCN 107237 Home health agency 5% Or Greater Indirect Ownership Interest (7.08%) Oct 29, 2021
Interim Healthcare Hospice - Sacramento AreaGold River, CA, CCN A11783 Hospice 5% Or Greater Indirect Ownership Interest (7.08%) Nov 4, 2021
Interim Healthcare San Jose LLCMandeville, LA, CCN 191681 Hospice 5% Or Greater Indirect Ownership Interest (7.08%) Dec 1, 2021
Interim Healthcare Hospice of AtlantaAtlanta, GA, CCN 851595 Hospice 5% Or Greater Indirect Ownership Interest (7.08%) Feb 17, 2023

Owned or controlled facilities with NPI records 12

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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": "1255910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552953600000",
    "number": "1891021390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 MINNEHAHA AVE BLDG 10",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554171647",
            "telephone_number": "612-548-5930",
            "fax_number": "612-548-5935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101 MINNEHAHA AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554171647",
            "telephone_number": "612-548-5930",
            "fax_number": "612-548-5935"
        }
    ],
    "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": "2009-10-19",
        "last_updated": "2019-03-19",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "CENTRAL PHARMACY, PHARMACIST SENIOR",
        "authorized_official_telephone_number": "612-548-5962"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MN",
            "license": "201261",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2413499",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minnesota Veterans Home - Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Minnesota Veterans Home Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.