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General NPI Number Information
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NPI Number | 1104641406
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Entity Type | Organization
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Legal Business Name | SPES RESIDENTIAL CARE L. L. C.
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 6336 WILRYAN AVE
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City | EDINA
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State | MN
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Zip | 55439-1444
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Country | US
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Telephone | 612-404-7208
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Fax |
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Provider Business Mailing Address
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Address Line | 6704 PLEASANT AVE
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City | RICHFIELD
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State | MN
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Zip | 55423-2351
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Country | US
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Telephone | 612-404-7208
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | SHARMAAN HAJIHUSSEIN
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Credential |
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Telephone | 612-481-7156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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