Healthcare Provider Details

I. General information

NPI: 1659139228
Provider Name (Legal Business Name): INSPIRED SENIOR LIVING OF HANOVER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10875 SETTLERS LN
HANOVER MN
55341-1400
US

IV. Provider business mailing address

7047 E GREENWAY PKWY STE 300
SCOTTSDALE AZ
85254-8116
US

V. Phone/Fax

Practice location:
  • Phone: 763-463-0708
  • Fax:
Mailing address:
  • Phone: 480-748-4339
  • 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: LUKE LEE
Title or Position: MANAGER
Credential:
Phone: 480-748-4339