PARK NICOLLET METHODIST HOSPITAL (NPI# 1578717336) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578717336 |
| Entity Type | Organization |
| Organization Name | PARK NICOLLET METHODIST HOSPITAL |
| Other Organization Name | PARK NICOLLET MELROSE CENTER |
| Practice Address |
3525 Monterey Dr St Louis Park MN 55416-5275 |
| Mailing Address |
Po Box 1488 Minneapolis MN 55480-1488 |
| Practice Telephone | 9529931990 |
| Practice Fax Number | 9529931980 |
| Mailing Telephone | 9529931990 |
| Mailing Fax Number | 9529931980 |
| Enumeration Date | 2008-11-06 |
| Last Update Date | 2019-09-09 |
| Authorized Official Name | MS. TRICIA L DEGE (SR VICE PRESIDENT, CFO) |
| Authorized Official Telephone | 9528835121 |
| Is Organization Subpart | Y |
| Parent Organization Name | PARK NICOLLET METHODIST HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Park Nicollet Melrose Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649827973 | Park Nicollet Methodist Hospital | Clinic/Center | 14050 Fairview Dr, Burnsville, MN 55337-5713 | 2019-08-21 |
| 1689112898 | Park Nicollet Methodist Hospital | Pharmacy | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2017-02-08 |
| 1174980692 | Park Nicollet Methodist Hospital | General Acute Care Hospital | 15800 95th Ave N, Maple Grove, MN 55369-4400 | 2016-01-28 |
| 1245615772 | Park Nicollet Methodist Hospital | General Acute Care Hospital | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2015-07-27 |
| 1194113217 | Park Nicollet Methodist Hospital | General Acute Care Hospital | 3900 Park Nicollet Blvd, St Louis Park, MN 55416-2503 | 2014-12-23 |
| 1942585286 | Park Nicollet Methodist Hospital | General Acute Care Hospital | 3525 Monterey Dr, St Louis Park, MN 55416-5275 | 2011-10-19 |
| 1942424742 | Park Nicollet Methodist Hospital | Pharmacy | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2007-04-12 |
| 1255478798 | Park Nicollet Methodist Hospital | Durable Medical Equipment & Medical Supplies | 6500 Excelsior Blvd, St Louis Park, MN 55426 | 2007-02-01 |
| 1083622047 | Park Nicollet Methodist Hospital | Anesthesiology | 6500 Excelsior Blvd, St Louis Park, MN 55426 | 2006-08-04 |
| 1447201421 | Park Nicollet Methodist Hospital | Home Health | 6500 Excelsior Blvd, St Louis Park, MN 55426 | 2006-05-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PARK NICOLLET METHODIST HOSPITAL | 6500 Excelsior Blvd, Saint Louis Park, MN 55426-4702 |
| Street Address |
3525 MONTEREY DR |
| City | ST LOUIS PARK |
| State | MN |
| Zip Code | 55416-5275 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275519563 | Deborah Mangham | Family Medicine | 3525 Monterey Dr, St Louis Park, MN 55416-5275 | 2005-12-19 |
| 1003440371 | Samantha Marie Slinger | Occupational Therapist | 3525 Monterey Dr, St Louis Park, MN 55416-5275 | 2020-02-26 |
| 1528603412 | Kelli Lynn Jones | Dietitian, Registered | 3525 Monterey Dr, St Louis Park, MN 55416-5275 | 2019-11-14 |
| 1558919068 | Lucy Ramquist | Dietitian, Registered | 3525 Monterey Dr, St Louis Park, MN 55416-5275 | 2019-08-28 |
| 1174170146 | Miranda Larson | Dietitian, Registered | 3525 Monterey Dr, St Louis Park, MN 55416-5275 | 2019-08-23 |
| 1467014043 | Kendra Rose Johnson | Occupational Therapist | 3525 Monterey Dr, St Louis Park, MN 55416-5275 | 2019-07-03 |
| 1669952180 | Hannah Paruzynski | Dietitian, Registered | 3525 Monterey Dr, St Louis Park, MN 55416 | 2018-08-14 |
| 1881114056 | Kaitlin Lezcano Lytle | Counselor | 3525 Monterey Dr, St Louis Park, MN 55416-5275 | 2017-06-20 |
| 1497283253 | John Leland Mckinley | Nurse Practitioner | 3525 Monterey Dr, St Louis Park, MN 55416 | 2017-05-24 |
| 1417483744 | Kayla Joy Muckenhirn | Occupational Therapist | 3525 Monterey Dr, St Louis Park, MN 55416-5275 | 2017-05-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639711492 | Ismahan Abdirahman Mohamed | Psychologist | 4236 Parkglen Rd, St Louis Park, MN 55416 | 2019-10-14 |
| 1598307860 | Ayman Abulaziz Mohamed | Counselor | 4326 Park Glen Rd, St Louis Park, MN 55416 | 2019-10-08 |
| 1831758929 | Ally Group Homes LLC | Assisted Living Facility | 2944 Princeton Ave South, Saint Louis Park, MN 55416 | 2019-06-11 |
| 1609371525 | Heather Margaret Flatgard | Chiropractor | 5407 Excelsior Blvd Ste D, St Louis Park, MN 55416 | 2018-03-25 |
| 1942702394 | Polaris Pharmacy Services of Minnesota, LLC | Pharmacy | 4220 Park Glen Road, St. Louis Park, MN 55416 | 2018-03-01 |
| 1316469760 | Evert Ray Boyd | Psychologist | 3200 Highway 100 S., Groves Academy, St Louis Park, MN 55416 | 2017-07-07 |
| 1861941684 | Amanda Marie Tapper | Marriage & Family Therapist | 5407 Excelsior Blvd, Suite B, St Louis Park, MN 55416 | 2016-09-22 |
| 1326410416 | Clear Health Chiropractic LLC | Chiropractor | 5614 W 36th St, St. Louis Park, MN 55416 | 2015-10-28 |
| 1568897833 | Kay Elizabeth Lichtenberger | Physical Therapist | 4415 W 36.5 St, St. Louis Park, MN 55416 | 2013-09-05 |
| 1710221510 | Aaron Christopher Oppelt | Counselor | 1665 Utica Ave South - Suite 100, Saint Louis Park, MN 55416 | 2012-11-16 |
| Find all providers in zip 55416 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730796384 | Maisa Inc. | Community Based Residential Treatment Facility, Mental Illness | 1113 E Franklin Ave Ste 208c, Minneapolis, MN 55404-2977 | 2020-09-28 |
| 1043837560 | Journey of Hope Community Housing LLC | Community Based Residential Treatment Facility, Mental Illness | 761 Case Ave, Saint Paul, MN 55106-3705 | 2020-06-30 |
| 1366005696 | Armando Cavazos | Community Based Residential Treatment Facility, Mental Illness | 84 Wabasha St S Apt 330, Saint Paul, MN 55107-1856 | 2019-04-22 |
| 1205300969 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 4835-4901 West Boradway Avenue, Crystal, MN 55429 | 2019-01-16 |
| 1871064840 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 300 8th Ave Ne, Minneapolis, MN 55413-2030 | 2018-12-17 |
| 1144791112 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 5546 7th St Ne, Fridley, MN 55432-5556 | 2018-12-17 |
| 1053882027 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 7701 Able St Ne, Spring Lake Park, MN 55432-2809 | 2018-12-17 |
| 1699246678 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 1140 80th Ave Ne, Spring Lake Park, MN 55432-2039 | 2018-12-17 |
| 1962973933 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 6134 Woody Ln Ne, Fridley, MN 55432-5844 | 2018-12-17 |
| 1780155754 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 500 Ironton St Ne, Fridley, MN 55432-1633 | 2018-12-17 |
| Find all providers with the same taxonomy | ||||
| City | ST LOUIS PARK |
| Zip Code | 55416 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.