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General NPI Number Information
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NPI Number | 1578236147
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Entity Type | Organization
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Legal Business Name | LUXISUITES LLC
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 10332 HOLLYWOOD BLVD NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-4515
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Country | US
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Telephone | 612-423-8624
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 290187
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-6187
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Country | US
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Telephone | 612-423-8624
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Fax |
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Authorized Official
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Title or Position | STAFF
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Name | SIMON PAYE
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Credential | RN
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Telephone | 612-423-8625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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