Provider Demographics
NPI:1861887986
Name:MOUNDS VIEW OPERATIONS, LLC
Entity type:Organization
Organization Name:MOUNDS VIEW OPERATIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-784-7633
Mailing Address - Street 1:2330 COUNTY HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:MOUNDS VIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1406
Mailing Address - Country:US
Mailing Address - Phone:763-784-7633
Mailing Address - Fax:
Practice Address - Street 1:2330 COUNTY HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:MOUNDS VIEW
Practice Address - State:MN
Practice Address - Zip Code:55112-1406
Practice Address - Country:US
Practice Address - Phone:763-784-7633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility