Healthcare Provider Details

I. General information

NPI: 1760303481
Provider Name (Legal Business Name): TERRACE HAVEN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 LINCOLN TER
COLUMBIA HEIGHTS MN
55421-1921
US

IV. Provider business mailing address

135 NATHAN LN N APT S328
PLYMOUTH MN
55441-6348
US

V. Phone/Fax

Practice location:
  • Phone: 612-472-5942
  • Fax:
Mailing address:
  • Phone: 612-472-5942
  • 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: MUNEEB MUSHTAQ
Title or Position: OWNER/MANAGING MEMBER
Credential: LALD
Phone: 612-472-5942