Provider Demographics
NPI:1881925345
Name:AMAZING LOVE ASSISTED LIVING LLC
Entity type:Organization
Organization Name:AMAZING LOVE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YEMMY
Authorized Official - Middle Name:T
Authorized Official - Last Name:OSONOWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-923-9413
Mailing Address - Street 1:5724 BASS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2747
Mailing Address - Country:US
Mailing Address - Phone:763-561-3434
Mailing Address - Fax:763-561-3636
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:763-561-3636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMAZING LOVE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN345634251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health