Organization
MINNESOTA HAVEN HOMES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SIA JAMILA SOGBEH RN (OWNER)
(612) 245-1658
Entity
Organization
Contact information
Practice address
8227 12TH AVE S, BLOOMINGTON, MN 55425-1709
(612) 245-1658
(763) 560-1419
Mailing address
8227 12TH AVE S, BLOOMINGTON, MN 55425-1709
(612) 245-1658
(763) 560-1419
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
R166070-8
MN
Other
Enumeration date
06/13/2007
Last updated
08/22/2020
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