Healthcare Provider Details

I. General information

NPI: 1265527832
Provider Name (Legal Business Name): AMAZING LOVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5724 BASS LAKE RD
CRYSTAL MN
55429-2747
US

IV. Provider business mailing address

5724 BASS LAKE RD
CRYSTAL MN
55429-2747
US

V. Phone/Fax

Practice location:
  • Phone: 763-561-3434
  • Fax: 763-561-3636
Mailing address:
  • Phone: 763-561-3434
  • Fax: 763-561-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number335677
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number333533
License Number StateMN

VIII. Authorized Official

Name: MR. HELEN ADAEZE OSONOWO
Title or Position: DIRECTOR OF NURSING
Credential:
Phone: 612-702-7412