Provider Demographics
NPI:1093903502
Name:SENIOR HOME LIVING INC
Entity Type:Organization
Organization Name:SENIOR HOME LIVING INC
Other - Org Name:MAPLEWOOD HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAOLEE
Authorized Official - Middle Name:CRYSTIE
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-456-6561
Mailing Address - Street 1:1736 COPE AVE E STE 2
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2661
Mailing Address - Country:US
Mailing Address - Phone:952-456-6561
Mailing Address - Fax:952-456-6563
Practice Address - Street 1:1736 COPE AVE E STE 2
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2661
Practice Address - Country:US
Practice Address - Phone:952-456-6561
Practice Address - Fax:952-456-6563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN337545251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA721135000Medicaid