Libin Residence LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

LIBIN RESIDENCE LLC

Practice address

1504 13TH St S
Saint Cloud, MN 56301-5418

Phone

(320) 291-9411

NPI assigned

Sep 23, 2024

Organization subpart

No

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

Authorized official

Name

Abyan Khalif Ahmed, OWNER

Title

Owner

Phone

(320) 291-9411

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1727049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727049600000",
    "number": "1407673221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 13TH ST S",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563015418",
            "telephone_number": "320-291-9411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 13TH ST S",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563015418",
            "telephone_number": "320-291-9411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBIN RESIDENCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-23",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "ABYAN",
        "authorized_official_middle_name": "KHALIF",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "320-291-9411",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenda Kathy Leyendecker I
• Seth Leyk
• Ryan Lezer, PHARM.D.
• Michael G Libby Jr.
• Libin Health LLC
• Karla Lien, LPN
• Shelby Elizabeth Lies, LPCC
• Thomas Matthias Lies
• Amber Lynn Lieser, CNP
• Lifeline Learning Center LLC

• Clinic/Center in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; 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.