Healthcare Provider Details

I. General information

NPI: 1922587039
Provider Name (Legal Business Name): MINNESOTA ADULT DAY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 ELTON HILLS DR NW
ROCHESTER MN
55901-2476
US

IV. Provider business mailing address

330 ELTON HILLS DR NW
ROCHESTER MN
55901-2476
US

V. Phone/Fax

Practice location:
  • Phone: 507-721-3179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: PLOENA HOANG
Title or Position: CEO
Credential:
Phone: 507-721-3179