Healthcare Provider Details

I. General information

NPI: 1518803659
Provider Name (Legal Business Name): GOOD CHAMBER ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2643 LONGFELLOW AVE
MINNEAPOLIS MN
55407-1245
US

IV. Provider business mailing address

2643 LONGFELLOW AVE
MINNEAPOLIS MN
55407-1245
US

V. Phone/Fax

Practice location:
  • Phone: 952-522-8082
  • Fax: 612-234-4610
Mailing address:
  • Phone: 952-522-8082
  • Fax: 612-234-4610

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: EBISA LEMU
Title or Position: MANAGER
Credential:
Phone: 612-607-4361