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Organization

HIGH DRIVE CUSTOMIZED/ASSISTED LIVING LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ANBASSA HAWIYA BUKULA NA (PROGRAM MANAGER (OWNER))
(763) 228-1804
Entity
Organization

Contact information

Practice address
13813 HIGH DR, BURNSVILLE, MN 55337-4740
(763) 228-1804
Mailing address
13813 HIGH DR, BURNSVILLE, MN 55337-4740
(763) 228-1804

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary

Other

Enumeration date
04/24/2023
Last updated
04/24/2023
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