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Organization
NEW LIFE HOME LLC
Active
Organization
NEW LIFE HOME LLC
Active
Other names
New Life Home
Organization subpart
No
Provider details
NPI number
Authorized official
MIRESSA JIBALO (OWNER)
(507) 329-5751
Entity
Organization
Contact information
Practice address
15300 DUNDEE CT, APPLE VALLEY, MN 55124-5887
(612) 441-2030
(612) 545-1758
Mailing address
15300 DUNDEE CT, APPLE VALLEY, MN 55124-5887
(612) 441-2030
(612) 545-1758
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
Other
Enumeration date
02/28/2024
Last updated
04/07/2024
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