Healthcare Provider Details

I. General information

NPI: 1003468166
Provider Name (Legal Business Name): CENTER FOR ENRICHMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 BAKKEN BLVD
COLUMBIA HTS MN
55421-5056
US

IV. Provider business mailing address

3825 BAKKEN BLVD
COLUMBIA HTS MN
55421-5056
US

V. Phone/Fax

Practice location:
  • Phone: 612-227-9597
  • Fax:
Mailing address:
  • Phone: 612-227-9597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SAGAL MUSE
Title or Position: MANAGER/OWNER
Credential:
Phone: 612-227-9507