MEDICARE: SOLACE ASSISTED LIVING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3104A0625X	Assisted Living Facility (Mental Illness)
2	3104A0630X	Assisted Living Facility (Behavioral Disturbances)
3	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1689374803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLACE ASSISTED LIVING

Provider Business Mailing Address
First Line	:	6718 QUAIL AVE N
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1656
Country	:	US
Telephone Number	:	612-814-8012
Fax Number	:

Provider Business Practice Location Address
First Line	:	6718 QUAIL AVE N
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1656
Country	:	US
Telephone Number	:	612-814-8012
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	UBAH A YUSUF
Credential	:
Telephone Number	:	612-229-1637

Provider Enumeration Date	:	03/07/2023
Last Update Date	:	03/07/2023

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Directions to “SOLACE ASSISTED LIVING ” Practice Location

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