Healthcare Provider Details

I. General information

NPI: 1295666543
Provider Name (Legal Business Name): MINDFUL CARE LIVING ASSISTED LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 63RD AVE N
BROOKLYN CENTER MN
55430-2001
US

IV. Provider business mailing address

2712 63RD AVE N
BROOKLYN CENTER MN
55430-2001
US

V. Phone/Fax

Practice location:
  • Phone: 612-483-1978
  • 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: HAMSA ADEN
Title or Position: MANAGER
Credential:
Phone: 612-483-1978