Organization
LIVING HOPE SECOND CHANCE LLC
Active
Parent organization
LIVING HOPE SECOND CHANCE LLC
Other names
Pro-Services Professinal Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIVING HOPE SECOND CHANCE LLC
Authorized official
TAVIA LYNNE ANDERSON (OWNER)
(612) 203-4535
Entity
Organization
Contact information
Practice address
7400 METRO BLVD STE 230, EDINA, MN 55439-2352
(612) 203-4535
(952) 217-4427
Mailing address
20455 CYPRESS DR, FARMINGTON, MN 55024-7319
(612) 203-4535
(952) 217-4427
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
175T00000X
Peer Specialist
—
—
251300000X
Local Education Agency (LEA)
—
—
251E00000X
Home Health Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
332U00000X
Home Delivered Meals
—
—
342000000X
Transportation Network Company
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
385H00000X
Respite Care
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
405300000X
Prevention Professional
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306350178
ANY HEALTHCARE RELATED IDENTIFIERS
MN
05
—
1306350178
—
MN
Enumeration date
11/30/2017
Last updated
10/16/2023
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