Healthcare Provider Details

I. General information

NPI: 1073356432
Provider Name (Legal Business Name): SUMMERWOODS HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8435 RED OAK DR
MOUNDS VIEW MN
55112
US

IV. Provider business mailing address

11911 BLUE SPRUCE CT
DAYTON MN
55327-4101
US

V. Phone/Fax

Practice location:
  • Phone: 952-256-2658
  • Fax:
Mailing address:
  • Phone: 952-256-2658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ZAINABU N OCHANDA
Title or Position: OWNER
Credential:
Phone: 651-399-6277