Healthcare Provider Details

I. General information

NPI: 1497689616
Provider Name (Legal Business Name): PARKVIEW GROUP HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 NEWTON AVE S
BLOOMINGTON MN
55431-2911
US

IV. Provider business mailing address

9901 NEWTON AVE S
BLOOMINGTON MN
55431-2911
US

V. Phone/Fax

Practice location:
  • Phone: 651-329-4662
  • Fax: 612-241-3395
Mailing address:
  • Phone: 651-329-4662
  • 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: KYRIAN AHAMEFULE NWOSU
Title or Position: RN
Credential: RN
Phone: 651-432-7226