Healthcare Provider Details

I. General information

NPI: 1609768985
Provider Name (Legal Business Name): STABLE HOUSING HSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 QUEBEC AVE N STE 105D
NEW HOPE MN
55427-1200
US

IV. Provider business mailing address

4124 QUEBEC AVE N STE 105D
NEW HOPE MN
55427-1200
US

V. Phone/Fax

Practice location:
  • Phone: 612-542-2493
  • Fax:
Mailing address:
  • Phone: 612-542-2493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: BIANCA NICOLE JUNIOR
Title or Position: OWNER
Credential:
Phone: 651-815-3819