Healthcare Provider Details

I. General information

NPI: 1740194935
Provider Name (Legal Business Name): ABUNDANT CARE RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2234 145TH AVE NW
ANDOVER MN
55304-3345
US

IV. Provider business mailing address

2234 145TH AVE NW
ANDOVER MN
55304-3345
US

V. Phone/Fax

Practice location:
  • Phone: 763-516-8536
  • Fax:
Mailing address:
  • Phone: 763-516-8536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. MIRIAM ORUCHO-OGUTU
Title or Position: ASSISTED LIVING DIRECTOR
Credential: CEO/OWNER
Phone: 763-516-8536