Healthcare Provider Details

I. General information

NPI: 1467371385
Provider Name (Legal Business Name): VIVENTA ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 VAN BUREN AVE
SAINT PAUL MN
55103-1538
US

IV. Provider business mailing address

12345 3RD ST NE
BLAINE MN
55434-1982
US

V. Phone/Fax

Practice location:
  • Phone: 651-357-8878
  • Fax:
Mailing address:
  • Phone: 651-357-8878
  • 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: GEMEDA ARGO
Title or Position: AUTHORIZED PERSON/OWNER
Credential:
Phone: 651-357-8878