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General NPI Number Information
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NPI Number | 1619776325
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Entity Type | Organization
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Legal Business Name | ALTITUDE LIVING INC
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 5681 277TH ST
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City | WYOMING
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State | MN
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Zip | 55092-9364
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Country | US
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Telephone | 612-246-2283
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Fax |
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Provider Business Mailing Address
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Address Line | 6109 BLUE CIRCLE DR STE 1000
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City | MINNETONKA
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State | MN
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Zip | 55343-9131
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YASIN SIYAD
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Credential |
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Telephone | 612-246-2283
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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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