NPI 1669110953

Kindred Supports LLC

Organisation Assisted Living Facility Prior Lake, MN

Practice location

Address: 5554 Woodside Rd SE, Prior Lake, MN 55372-2044
Phone: (612) 810-9796
Mailing address: 4220 157th St W, Rosemount, MN 55068-4600

Authorised official

Name: Anthony Gjorvad
Title: Owner
Phone: (612) 812-9786

Registered specialties

Assisted Living Facility Primary

Nursing & Custodial Care Facilities Taxonomy 310400000X

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Registry record

NPI: 1669110953
Entity type: Organization
NPI issued: 25 May 2022
Record last updated: 25 May 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.