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General NPI Number Information
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NPI Number | 1477271823
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Entity Type | Organization
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Legal Business Name | BALANCED LIVING, L.L.C
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 16019 ESTATE LN
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City | LAKEVILLE
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State | MN
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Zip | 55044-2269
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Country | US
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Telephone | 763-203-9496
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Fax |
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Provider Business Mailing Address
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Address Line | 16019 ESTATE LN
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City | LAKEVILLE
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State | MN
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Zip | 55044-2269
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Country | US
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Telephone | 763-203-9496
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. NASRA HASSAN GIAM
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Credential | DNP
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Telephone | 763-203-9496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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