Healthcare Provider Details

I. General information

NPI: 1326696832
Provider Name (Legal Business Name): NORTH RIDGE ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 BOONE AVE N
NEW HOPE MN
55428-3615
US

IV. Provider business mailing address

5430 BOONE AVE N
NEW HOPE MN
55428-3615
US

V. Phone/Fax

Practice location:
  • Phone: 763-592-3000
  • Fax: 763-592-2999
Mailing address:
  • Phone: 763-592-3000
  • Fax: 763-592-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE M DELKER
Title or Position: CFO
Credential:
Phone: 813-321-1239