Living Hope Second Chance LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

LIVING HOPE SECOND CHANCE LLC

Doing business as

Pro-Services Professinal Services

Practice address

7400 Metro Blvd Ste 230
Edina, MN 55439-2352

Phone

(612) 203-4535

Fax

(952) 217-4427

NPI assigned

Nov 30, 2017

Organization subpart

Yes

Parent organization

LIVING HOPE SECOND CHANCE LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tavia Lynne Anderson

Title

Owner

Phone

(612) 203-4535

Specialties & licenses 12

Addresses

Other identifiers 2

Other names 1

• Pro-Services Professinal Services Doing business as

Electronic endpoints 1

Part of

Living Hope Second Chance LLC

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697414400000",
    "number": "1306350178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20455 CYPRESS DR",
            "city": "FARMINGTON",
            "state": "MN",
            "postal_code": "550247319",
            "telephone_number": "612-203-4535",
            "fax_number": "952-217-4427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 METRO BLVD STE 230",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554392352",
            "telephone_number": "612-203-4535",
            "fax_number": "952-217-4427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING HOPE SECOND CHANCE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIVING HOPE SECOND CHANCE LLC",
        "enumeration_date": "2017-11-30",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "TAVIA",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-203-4535"
    },
    "taxonomies": [
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332U00000X",
            "taxonomy_group": "",
            "desc": "Home Delivered Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "342000000X",
            "taxonomy_group": "",
            "desc": "Transportation Network Company",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2055X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Mental Illness, Child",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "405300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Prevention Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306350178",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANY HEALTHCARE RELATED IDENTIFIERS",
            "identifier": "1306350178",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "taviaanderson@livinghopesecondchance.com",
            "affiliation": "Y",
            "affiliationName": "Living Hope Second Chance LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "7400 Metro Blvd Ste 230",
            "city": "Edina",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554392352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Pro-Services Professinal Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Noam Littman, MD
• Heng-Hsiao E Liu, M.D.
• Wei Liu, L.AC
• Live Well MN (Live Well MN Home Healthcare)
• Live Well MN LLC (Live Well MN Home Healthcare)
• Rachel Livingston
• Theodore Edward Lobby, MSW
• Dianne Lynn Lockman, M.S., RN, CNS
• Steven D Lockman, MD
• Cynthia Tomara Lodermeier, APRN, CNP

• Clinic/Center in Edina, MN
• Providers in Edina, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.