Healthcare Provider Details

I. General information

NPI: 1144370610
Provider Name (Legal Business Name): PRIDE N LIVING HOME CARE INC .
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7691 CENTRAL AVE NE SUITE 102
FRIDLEY MN
55432-3560
US

IV. Provider business mailing address

7691 CENTRAL AVE NE SUITE 102
FRIDLEY MN
55432-3560
US

V. Phone/Fax

Practice location:
  • Phone: 763-572-2390
  • Fax: 763-574-2459
Mailing address:
  • Phone: 763-572-2390
  • Fax: 763-574-2459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberR 138395-9
License Number StateMN

VIII. Authorized Official

Name: KAREN NABUIN WAINDIM
Title or Position: CEO
Credential:
Phone: 651-271-2291