MEDICARE: LUXE HOME RESIDENTIAL SERVICES 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	:	1891512901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUXE HOME RESIDENTIAL SERVICES LLC

Provider Business Mailing Address
First Line	:	1144 36 1/2 AVE NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-1303
Country	:	US
Telephone Number	:	612-404-6590
Fax Number	:

Provider Business Practice Location Address
First Line	:	1144 36 1/2 AVE NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-1303
Country	:	US
Telephone Number	:	612-404-6590
Fax Number	:

Authorized Official
Title or Position	:	MANANGER
Name	:	SALEBAN M OMAR
Credential	:
Telephone Number	:	612-404-6590

Provider Enumeration Date	:	09/21/2024
Last Update Date	:	09/21/2024

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