Healthcare Provider Details

I. General information

NPI: 1780515585
Provider Name (Legal Business Name): CHOICEWAY RESIDENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 PORTLAND AVE
RICHFIELD MN
55423-3220
US

IV. Provider business mailing address

7301 PORTLAND AVE
RICHFIELD MN
55423-3220
US

V. Phone/Fax

Practice location:
  • Phone: 651-588-6916
  • Fax:
Mailing address:
  • Phone: 651-588-6916
  • Fax:

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: MR. IBRAHIM ABDI FARAH
Title or Position: OWNER
Credential:
Phone: 651-588-6916