Healthcare Provider Details

I. General information

NPI: 1285564328
Provider Name (Legal Business Name): POPLAR BRIDGE HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 POPLAR BRIDGE RD
BLOOMINGTON MN
55437-1602
US

IV. Provider business mailing address

4108 POPLAR BRIDGE RD
BLOOMINGTON MN
55437-1602
US

V. Phone/Fax

Practice location:
  • Phone: 763-607-2072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NAJMA DHAQANE
Title or Position: OWNER
Credential:
Phone: 763-607-2072