Healthcare Provider Details

I. General information

NPI: 1932419504
Provider Name (Legal Business Name): ASIAN AMERICAN ELDERLY ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 MINNEHAHA AVE E
SAINT PAUL MN
55119-3931
US

IV. Provider business mailing address

7106 NEWTON AVE N
BROOKLYN CENTER MN
55430-1041
US

V. Phone/Fax

Practice location:
  • Phone: 763-245-7701
  • Fax: 763-569-0127
Mailing address:
  • Phone: 763-245-7701
  • Fax: 763-569-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License NumberA447698000
License Number StateMN

VIII. Authorized Official

Name: MRS. CHAO VANG
Title or Position: DIRECTOR
Credential:
Phone: 763-245-7701