Provider Demographics
NPI:1922889815
Name:AMAZE QUALITY LIVING LLC
Entity Type:Organization
Organization Name:AMAZE QUALITY LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-306-2400
Mailing Address - Street 1:3908 SUNSET RD N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1221
Mailing Address - Country:US
Mailing Address - Phone:763-306-2400
Mailing Address - Fax:
Practice Address - Street 1:3908 SUNSET RD N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1221
Practice Address - Country:US
Practice Address - Phone:763-306-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility