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General NPI Number Information
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NPI Number | 1508291592
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Entity Type | Organization
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Legal Business Name | HOPE SENIOR CENTER, LLC
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 1730 GERVAIS AVE
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City | MAPLEWOOD
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State | MN
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Zip | 55109-2134
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Country | US
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Telephone | 651-340-3887
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Fax | 651-756-7346
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Provider Business Mailing Address
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Address Line | 1730 GERVAIS AVE
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City | MAPLEWOOD
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State | MN
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Zip | 55109-2134
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Country | US
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Telephone | 651-340-3887
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Fax | 651-756-7346
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Authorized Official
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Title or Position | DIRECTOR
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Name | HAWJ XIONG
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Credential |
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Telephone | 612-237-0882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 1065881-2-ADC
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License Number State | MN
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