Provider Demographics
NPI:1194705830
Name:LITTLE SISTERS OF THE POOR OF ST PAUL
Entity type:Organization
Organization Name:LITTLE SISTERS OF THE POOR OF ST PAUL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-227-0336
Mailing Address - Street 1:330 EXCHANGE ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2311
Mailing Address - Country:US
Mailing Address - Phone:651-227-0336
Mailing Address - Fax:651-227-7321
Practice Address - Street 1:330 EXCHANGE ST S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2311
Practice Address - Country:US
Practice Address - Phone:651-227-0336
Practice Address - Fax:651-227-7321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN825540700Medicaid
MN245524Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION N