Healthcare Provider Details

I. General information

NPI: 1487247557
Provider Name (Legal Business Name): HMONG ADULT DAY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 RICE ST STE 1
SAINT PAUL MN
55117-3864
US

IV. Provider business mailing address

1459 RICE ST STE 1
SAINT PAUL MN
55117-3864
US

V. Phone/Fax

Practice location:
  • Phone: 651-528-8755
  • Fax: 651-776-5251
Mailing address:
  • Phone: 651-528-8755
  • Fax: 651-776-5251

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: BOUANGEUNE YANG LOR
Title or Position: PRESIDENT
Credential:
Phone: 651-528-8755