Healthcare Provider Details

I. General information

NPI: 1376128470
Provider Name (Legal Business Name): PALLADIUM ADULT DAY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9673 63RD AVE N
MAPLE GROVE MN
55369-6253
US

IV. Provider business mailing address

9673 63RD AVE N
MAPLE GROVE MN
55369-6253
US

V. Phone/Fax

Practice location:
  • Phone: 612-296-8931
  • Fax:
Mailing address:
  • Phone: 612-296-8931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NELLA MALOYLO
Title or Position: OWNER
Credential:
Phone: 612-296-8931