Provider Demographics
NPI:1063535276
Name:VOLUNTEERS OF AMERICA HOMESTEAD 2000, INC.
Entity type:Organization
Organization Name:VOLUNTEERS OF AMERICA HOMESTEAD 2000, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-941-0305
Mailing Address - Street 1:7485 OFFICE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3690
Mailing Address - Country:US
Mailing Address - Phone:952-941-0305
Mailing Address - Fax:952-941-0428
Practice Address - Street 1:2835 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-6066
Practice Address - Country:US
Practice Address - Phone:970-243-7224
Practice Address - Fax:970-243-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAL-0206310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97229733Medicaid