Healthcare Provider Details

I. General information

NPI: 1548817620
Provider Name (Legal Business Name): AFFINITY RESIDENTIAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 94TH ST STE 5
BLOOMINGTON MN
55431-2341
US

IV. Provider business mailing address

2001 W 94TH ST STE 5
BLOOMINGTON MN
55431-2341
US

V. Phone/Fax

Practice location:
  • Phone: 952-217-4750
  • Fax: 612-930-0108
Mailing address:
  • Phone: 612-386-0942
  • Fax: 612-930-0108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: ZAHNIA AMINAH HARUT
Title or Position: OWNER
Credential: RN
Phone: 612-386-0942