FIRST LIGHT RESIDENTIAL CARE LLC NPI 1386297547

NPI Information

FIRST LIGHT RESIDENTIAL CARE LLC is an assisted living facility in St Louis Park, MN. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. FIRST LIGHT RESIDENTIAL CARE LLC NPI is 1386297547. The provider is registered as an organization entity type.

The provider's business location address is:

2935 AQUILA AVE S
ST LOUIS PARK, MN
ZIP 55426-953
Phone: (612) 404-7552

The provider's authorized official is Sofia H Mohamed .
The authorized official title is Owner and has the following contact phone number (612) 404-7552.

The CLIA number assigned to this NPI record is 24D2179689 - home health agency with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/17/2019 and was last updated on 7/17/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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