Charity Alabo

Individual provider Active NPI Assisted Living Facility · Blaine, MN

NPI 1023736634 · NPPES record last updated Aug 19, 2022

Key facts

NPI
1023736634
Entity type
Individual (NPI type 1)
Primary specialty
Assisted Living Facility 310400000X
License
408505 (MN)
Practice address
3912 86TH Lane NE
Blaine, MN 55014
Phone
(612) 558-8999
NPI assigned
Aug 19, 2022
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
408505MNMDAssisted Living Facility

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 408505 MN Yes

Addresses

Primary practice location

3912 86TH Lane NE
Blaine, MN 55014

Mailing address

3912 86TH Lane NE
Blaine, MN 55014
Phone (612) 558-8999

Other providers in Blaine, MN

All providers in Blaine, MN · Assisted Living Facility in Minnesota

Sources for this page

Verify at the official NPI Registry.