Healthcare Provider Details

I. General information

NPI: 1184544538
Provider Name (Legal Business Name): A BLOOMING GRACE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 BETHIA LN
BROOKLYN PARK MN
55428-1721
US

IV. Provider business mailing address

6600 BETHIA LN
BROOKLYN PARK MN
55428-1721
US

V. Phone/Fax

Practice location:
  • Phone: 612-361-7902
  • Fax: 612-435-9750
Mailing address:
  • Phone: 612-361-7902
  • Fax: 612-435-9750

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: FARHIYA BASHIR OMAR-SAMATAT
Title or Position: OWNER
Credential:
Phone: 612-840-4182