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General NPI Number Information
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NPI Number | 1245883651
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Entity Type | Organization
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Legal Business Name | SISTERS ASSISTANT LIVING CARE LLC
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 12/28/2022
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Provider Practice Location Address
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Address Line | 1129 COUNTY ROAD B2 W
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City | ROSEVILLE
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State | MN
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Zip | 55113-3237
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Country | US
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Telephone | 619-846-8860
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Fax | 651-331-4387
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Provider Business Mailing Address
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Address Line | 2233 HAMLINE AVE N STE 605
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City | ROSEVILLE
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State | MN
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Zip | 55113-5007
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Country | US
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Telephone | 651-358-3188
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Fax | 651-331-4387
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MAX GARDAD
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Credential |
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Telephone | 651-358-3188
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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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