Provider Demographics
NPI:1023724838
Name:STATE OF MINNESOTA MINNESOTA MANAGEMENT AND BUDGET
Entity type:Organization
Organization Name:STATE OF MINNESOTA MINNESOTA MANAGEMENT AND BUDGET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MDVA HEALTHCARE DEPUTY COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-757-1570
Mailing Address - Street 1:5101 MINNEHAHA AVE. S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:920 ANNE STREET N.W.
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5104
Practice Address - Country:US
Practice Address - Phone:218-308-2759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF MINNESOTA MINNESOTA MANAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility