Healthcare Provider Details

I. General information

NPI: 1801972963
Provider Name (Legal Business Name): MOMENT OF IMPACT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8456-BRUNSWICK CT N
MINNEAPOLIS MN
55443
US

IV. Provider business mailing address

8456-BRUNSWICK CT N
MINNEAPOLIS MN
55443
US

V. Phone/Fax

Practice location:
  • Phone: 763-416-0095
  • Fax: 763-515-7889
Mailing address:
  • Phone: 763-416-0095
  • Fax: 763-515-7889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number1040454-1-CFC
License Number StateMN

VIII. Authorized Official

Name: MR. PATRICK IMHANYIANBHO UGIAGBE
Title or Position: ADMINISTRATOR
Credential:
Phone: 763-227-4131