Healthcare Provider Details

I. General information

NPI: 1235011016
Provider Name (Legal Business Name): LOVEWORLD SUPPORT SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14485 SNOWY OWL ST NW
RAMSEY MN
55303-4396
US

IV. Provider business mailing address

14485 SNOWY OWL ST NW
RAMSEY MN
55303-4396
US

V. Phone/Fax

Practice location:
  • Phone: 651-502-4792
  • Fax:
Mailing address:
  • Phone: 651-502-4792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NIKEL TAKANG NSHOM
Title or Position: OWNER
Credential:
Phone: 651-502-4792