Organization
ENRICHED LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRYAN JOHNSON (OWNER)
(612) 930-2265
Entity
Organization
Contact information
Practice address
301 COUNTY ROAD E2 W, NEW BRIGHTON, MN 55112-6859
(651) 505-6766
(651) 846-5633
Mailing address
301 COUNTY ROAD E2 W, NEW BRIGHTON, MN 55112-6859
(651) 505-6761
(651) 846-5633
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1086810
MN
253Z00000X
In Home Supportive Care Agency
—
—
310400000X
Assisted Living Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1086810
—
MN
Enumeration date
09/19/2017
Last updated
03/20/2026
Update your record
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