Provider Demographics
NPI:1508566555
Name:SECURED HEALTH AND HOME ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:SECURED HEALTH AND HOME ASSISTED LIVING LLC
Other - Org Name:SECURED HEALTH ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:IJADIMBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:ALD
Authorized Official - Phone:763-438-8869
Mailing Address - Street 1:4519 104TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1030
Mailing Address - Country:US
Mailing Address - Phone:763-438-8869
Mailing Address - Fax:763-207-1086
Practice Address - Street 1:10410 CROCUS ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4513
Practice Address - Country:US
Practice Address - Phone:763-438-8869
Practice Address - Fax:763-207-1086
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SECURED HEALTH AND HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances