Provider Demographics
NPI:1093403180
Name:TEOBI ENTERPRISE LLC
Entity Type:Organization
Organization Name:TEOBI ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THANH TAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-598-2845
Mailing Address - Street 1:PO BOX 390445
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-0445
Mailing Address - Country:US
Mailing Address - Phone:612-598-2845
Mailing Address - Fax:
Practice Address - Street 1:5724 BASS LAKE RD
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-2747
Practice Address - Country:US
Practice Address - Phone:763-561-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility