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General NPI Number Information
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NPI Number | 1619441979
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Entity Type | Organization
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Legal Business Name | FRIENDSHIP PLACE
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 152 KING ST W
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City | SAINT PAUL
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State | MN
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Zip | 55107-2723
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Country | US
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Telephone | 612-619-3848
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Fax |
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Provider Business Mailing Address
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Address Line | 169 CIMARRON RD
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City | APPLE VALLEY
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State | MN
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Zip | 55124-9724
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Country | US
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Telephone | 612-619-3848
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KOSHIN M. HASSAN
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Credential |
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Telephone | 612-619-3848
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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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