| Enriched Living Llc | |
|
2520 Coon Rapids Blvd Nw Ste 100 Coon Rapids MN 55433-3908 | |
| (612) 930-2265 | |
| Not Available |
| Full Name | Enriched Living Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2520 Coon Rapids Blvd Nw Ste 100, Coon Rapids, Minnesota |
| Authorized Official Name and Position | Tryan Johnson (OWNER) |
| Authorized Official Contact | 6129302265 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Enriched Living Llc 639 Stryler Ave St. Paul MN 55107 Ph: (612) 930-2265 | Enriched Living Llc 2520 Coon Rapids Blvd Nw Ste 100 Coon Rapids MN 55433-3908 Ph: (612) 930-2265 |
| NPI Number | 1780103929 |
|---|---|
| Provider Enumeration Date | 09/19/2017 |
| Last Update Date | 07/21/2022 |
| Certification Date | 01/04/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780103929 | NPI | - | NPPES |
| 1086810 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1086810 (Minnesota) | Primary |
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