Providence Health Care Services

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PROVIDENCE HEALTH CARE SERVICES

Practice address

781 103Rd Ave NE
Blaine, MN 55434-4507

Phone

(612) 456-2773

Fax

(763) 374-4469

NPI assigned

Apr 17, 2023

Organization subpart

No

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

Authorized official

Name

Jared Kenyanya, RN

Title

Ceo

Phone

(612) 456-2773

Specialties & licenses 1

Addresses

Other names 1

• Sunrise Assisted Living Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748563200000",
    "number": "1457047037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "781 103RD AVE NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344507",
            "telephone_number": "612-456-2773",
            "fax_number": "763-374-4469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "781 103RD AVE NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344507",
            "telephone_number": "612-456-2773",
            "fax_number": "763-374-4469"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15236 Germanium Cir NW",
            "address_purpose": "LOCATION",
            "city": "Ramsey",
            "state": "MN",
            "postal_code": "553035163",
            "country_code": "US",
            "telephone_number": "763-444-1811",
            "fax_number": "763-444-1868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH CARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-17",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A",
        "authorized_official_last_name": "KENYANYA",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "612-456-2773",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunrise Assisted Living",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Assisted Living Facility in Blaine, MN
• Providers in Blaine, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.