NEW LIFE HOME LLC NPI 1063279834

NPI Information

  • NPI: 1063279834
  • Provider Name: NEW LIFE HOME LLC
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • CLIA Number: 24D2269366
  • Address: 15300 DUNDEE CT
    APPLE VALLEY, MN
    ZIP 55124
  • Phone: (612) 441-2030

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NPI Details

NEW LIFE HOME LLC is an assisted living facility in Apple Valley, 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. NEW LIFE HOME LLC NPI is 1063279834. The provider is registered as an organization entity type.

The provider's business location address is:

15300 DUNDEE CT
APPLE VALLEY, MN
ZIP 55124-887
Phone: (612) 441-2030
Fax: (612) 545-1758

The provider's authorized official is Miressa Jibalo .
The authorized official title is Owner and has the following contact phone number (507) 329-5751.

The CLIA number assigned to this NPI record is 24D2269366 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/28/2024 and was last updated on 4/7/2024.

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityYes
23104A0625XAssisted Living FacilityAssisted Living, Mental IllnessNo
33104A0630XAssisted Living FacilityAssisted Living, Behavioral DisturbancesNo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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