Organization
GRACE GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASIA AHMED ALI (OWNER/MANAGER)
(612) 598-9923
Entity
Organization
Contact information
Practice address
3538 FREMONT AVE N, MINNEAPOLIS, MN 55412
(612) 598-9923
Mailing address
3538 FREMONT AVE N, MINNEAPOLIS, MN 55412
(612) 598-9923
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
310400000X
Assisted Living Facility
Primary
—
—
332U00000X
Home Delivered Meals
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34790
—
MN
Enumeration date
06/11/2019
Last updated
06/11/2019
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