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NPI 1710010202 · Nursing Facility/Intermediate Care Facility · Saint Paul, MN
Provider details
- NPI number
- 1710010202
- Entity type
- Organization
- Primary specialty
- Nursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Kiros Tesfaye, Business Manager(657) 647-0017
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1255 Larpenteur Ave W
Saint Paul, MN 55113-6337
Phone: (651) 647-0017
Street-level locationGet directions
Mailing address
1255 Larpenteur Ave W
Saint Paul, MN 55113-6337
Registry dates
- Enumerated
- 2007-03-13
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.