Healthcare Provider Details

I. General information

NPI: 1700519741
Provider Name (Legal Business Name): MOUNT ZION CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 RIDGE AVE
ANOKA MN
55303-1489
US

IV. Provider business mailing address

7211 208TH CIR N
FOREST LAKE MN
55025-2903
US

V. Phone/Fax

Practice location:
  • Phone: 515-918-3955
  • Fax:
Mailing address:
  • Phone: 515-918-3955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: AZIE KHAN
Title or Position: ASSISTED LIVING DIRECTOR
Credential: RN
Phone: 515-918-3955