MEDICARE: SHAXLE ASSISTED LIVING INC

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	:	1902785405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAXLE ASSISTED LIVING INC

Provider Business Mailing Address
First Line	:	6237 LEE AVE N
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-2477
Country	:	US
Telephone Number	:	612-483-7658
Fax Number	:

Provider Business Practice Location Address
First Line	:	6237 LEE AVE N
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-2477
Country	:	US
Telephone Number	:	612-483-7658
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABDULKADIR JAMA
Credential	:
Telephone Number	:	612-483-7658

Provider Enumeration Date	:	08/28/2025
Last Update Date	:	08/28/2025

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Directions to “SHAXLE ASSISTED LIVING INC ” Practice Location

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