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General NPI Number Information
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NPI Number | 1760137095
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Entity Type | Organization
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Legal Business Name | BELLA VIE LIVING
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 7001 EMERSON AVE N
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City | BROOKLYN CENTER
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State | MN
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Zip | 55430-1106
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Country | US
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Telephone | 651-356-1273
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Fax |
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Provider Business Mailing Address
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Address Line | 4015 COUNTY ROAD 25 APT 201
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City | MINNEAPOLIS
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State | MN
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Zip | 55416-3484
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Country | US
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Telephone | 651-356-1273
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARA K JENSON
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Credential | RN
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Telephone | 651-356-1273
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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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