MEDICARE: PROMISE CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1518780386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMISE CARE LLC

Provider Business Mailing Address
First Line	:	6559 UPPER 20TH ST N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55128-4321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6559 UPPER 20TH ST N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55128-4321
Country	:	US
Telephone Number	:	651-278-5231
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KERIA KASSIM
Credential	:
Telephone Number	:	763-910-7725

Provider Enumeration Date	:	10/31/2024
Last Update Date	:	10/31/2024

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Directions to “PROMISE CARE LLC ” Practice Location

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