Grand Avenue Rest Home Inc

Primary specialty

Mental Illness Intermediate Care FacilityTaxonomy code 310500000X

Legal business name

GRAND AVENUE REST HOME INC

Practice address

3956 Grand Ave S
Minneapolis, MN 55409-1535

Phone

(612) 824-1434

Fax

(612) 824-2219

NPI assigned

Oct 1, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Nancy Lynn Soderbeck

Title

Acting Administrator

Phone

(612) 824-1434

Specialties & licenses 1

Addresses

Other names 1

• Grand Avenue Residence Other name

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

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert G Sonntag, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Minneapolis, MN
  • NPI 1699741397
  NPD (past)

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

{
    "created_epoch": "1128124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932196235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3956 GRAND AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554091535",
            "telephone_number": "612-824-1434",
            "fax_number": "612-824-2219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3956 GRAND AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554091535",
            "telephone_number": "612-824-1434",
            "fax_number": "612-824-2219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND AVENUE REST HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SODERBECK",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "ACTING ADMINISTRATOR",
        "authorized_official_telephone_number": "612-824-1434",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Avenue Residence",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Gary L Grammens, M.D.
• Kevin Grams
• Kristine Granacher, LMFT
• Michele D Granada, MD
• Carrie Jean Granbois, CNP, APRN
• Grand Home Health Serive Inc
• Grand St Paul CVS LLC (CVS Pharmacy #16714)
• Grand St Paul CVS LLC (CVS Pharmacy #05996)
• Grand St Paul CVS LLC (CVS Pharmacy #16471)
• Grand St Paul CVS LLC (CVS Pharmacy #17626)

• Mental Illness Intermediate Care Facility in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Mental Illness Intermediate Care 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.
• 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.