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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