MEDICARE: NEW HORIZON ASSISTED LIVING 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	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1578171518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HORIZON ASSISTED LIVING LLC

Provider Business Mailing Address
First Line	:	6825 71ST AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428-1736
Country	:	US
Telephone Number	:	952-393-1596
Fax Number	:

Provider Business Practice Location Address
First Line	:	5916 71ST AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55429-1005
Country	:	US
Telephone Number	:	952-393-1596
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MRS. SARAH R MORABU
Credential	:	RN
Telephone Number	:	952-393-1596

Provider Enumeration Date	:	07/15/2020
Last Update Date	:	07/15/2020

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