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General NPI Number Information
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NPI Number | 1649087768
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Entity Type | Organization
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Legal Business Name | SERENITY LIVING SOLUTIONS OF BLACKDUCK LLC
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 441 4TH ST NE
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City | BLACKDUCK
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State | MN
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Zip | 56630-2167
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Country | US
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Telephone | 651-374-1619
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Fax |
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Provider Business Mailing Address
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Address Line | 2277 HIGHWAY 36 W STE 300
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City | ROSEVILLE
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State | MN
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Zip | 55113-3830
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Country | US
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Telephone | 651-374-1619
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ABDULLAHI OMAR
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Credential |
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Telephone | 651-374-1619
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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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