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General NPI Number Information
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NPI Number | 1295557536
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Entity Type | Organization
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Legal Business Name | MAI HERO, LLC
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 6609 NEDDERSEN PKWY
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City | BROOKLYN PARK
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State | MN
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Zip | 55445-3204
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Country | US
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Telephone | 763-464-2681
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Fax |
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Provider Business Mailing Address
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Address Line | 6609 NEDDERSEN PKWY
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City | BROOKLYN PARK
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State | MN
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Zip | 55445-3204
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Country | US
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Telephone | 763-464-2681
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAI NOU THAO
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Credential |
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Telephone | 763-464-2681
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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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