Individual provider · Type 1 NPI
Phouvieng Sivilay
Assisted Living Facility · Eden Prairie, MN
NPI number
1245012715
Active
Practice location
10452 Spyglass Dr
Eden Prairie, MN 55347-4656
Mailing address
10428 Shelter Grv
Eden Prairie, MN 55347-4855
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Assisted Living Facility Primary | 310400000X | 39902 (MN) |
Assisted Living Facility: 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.
Another provider at this address
About NPI 1245012715
Phouvieng Sivilay's National Provider Identifier is 1245012715, issued on Oct 18, 2023. The primary taxonomy on file is Assisted Living Facility (310400000X), and the practice location is in Eden Prairie, MN. The record was last updated on Oct 18, 2023.