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Contact Information

PHS MARANATHA INC.
5409 69TH AVE N
BROOKLYN CENTER, MN55429-1505
 Phone: 763-549-9600
 Fax: 763-549-9636
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
 

Nursing Facility/Intermediate Care Facility

313M00000X A3[10] Other Nursing Facility
Indicates primary specialty

NPI Profile & details for PHS MARANATHA INC.

NPI # 1346245446
LBN Legal business name PHS MARANATHA INC.
Authorized official MARK MEYER - (CFO)
Entity Organization
Organization subpart 1 No
Enumeration date 06/15/2005
Last updated 11/11/2025 - About 7 months ago
Identifiers
MN License # 328432
MN Medicaid 731342000
MN Other NH0032 UCARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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