Healthcare Provider Details

I. General information

NPI: 1861367690
Provider Name (Legal Business Name): CARING HEART ASSITED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13223 YUKON ST NW
MINNEAPOLIS MN
55448-1233
US

IV. Provider business mailing address

13223 YUKON ST NW
MINNEAPOLIS MN
55448-1233
US

V. Phone/Fax

Practice location:
  • Phone: 952-999-0771
  • Fax:
Mailing address:
  • Phone: 952-999-0771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: SERAY MBALU LANSANA
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 952-999-0771