=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194646380
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEACEFUL HEART HEALTH GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2026
-----------------------------------------------------
Last Update Date | 07/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7801 MISSISSIPPI LN
-----------------------------------------------------
City | BROOKLYN PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55444-2151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-296-1026
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7801 MISSISSIPPI LN
-----------------------------------------------------
City | BROOKLYN PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55444-2151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-296-1026
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | SUKURAT OPAREMI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 612-203-7168
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------