Provider Demographics
NPI:1699762195
Name:JONES HARRISON RESIDENCE CORPORATION
Entity type:Organization
Organization Name:JONES HARRISON RESIDENCE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-920-2030
Mailing Address - Street 1:3700 CEDAR LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4240
Mailing Address - Country:US
Mailing Address - Phone:612-920-2030
Mailing Address - Fax:612-920-2824
Practice Address - Street 1:3700 CEDAR LAKE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4240
Practice Address - Country:US
Practice Address - Phone:612-920-2030
Practice Address - Fax:612-920-2824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN329866251E00000X
MNL14827307310400000X
MN328173314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN461242600Medicaid
7122738OtherMEDICA
9626TOOtherBCBS