=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033810015
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARDENVIEW HOME HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2023
-----------------------------------------------------
Last Update Date | 03/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 E 100TH ST
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55420-5031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-229-4752
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 E 100TH ST
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55420-5031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-229-4752
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTED LIVING DIRECTOR
-----------------------------------------------------
Name | SAGAL ABDURAHMAN MOHAMED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 612-229-4752
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------