Organization
WILLOW RESIDENCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAISA YASIN HUSSEIN (OWNER)
(612) 913-2975
Entity
Organization
Contact information
Practice address
3208 PARK AVE, MINNEAPOLIS, MN 55407-2008
(612) 913-2975
Mailing address
3208 PARK AVE, MINNEAPOLIS, MN 55407-2008
(612) 913-2975
(612) 444-8984
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
01/01/2024
Last updated
01/18/2024
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