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General NPI Number Information
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NPI Number | 1093903502
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Entity Type | Organization
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Legal Business Name | SENIOR HOME LIVING INC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 1736 COPE AVE E STE 2
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City | MAPLEWOOD
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State | MN
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Zip | 55109-2661
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Country | US
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Telephone | 952-456-6561
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Fax | 952-456-6563
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Provider Business Mailing Address
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Address Line | 1736 COPE AVE E STE 2
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City | MAPLEWOOD
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State | MN
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Zip | 55109-2661
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Country | US
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Telephone | 952-456-6561
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Fax | 952-456-6563
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Authorized Official
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Title or Position | OWNER
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Name | GAOLEE CRYSTIE YANG
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Credential |
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Telephone | 952-456-6561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 337545
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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