AT HOME ASSISTED LIVING LLC, FRIDLEY

provider_name-AT HOME ASSISTED LIVING LLC

physical_address- 1335 52ND AVE NE

physical_city-FRIDLEY

physical_state -MN

physical_zip- 55421

county_name-ANOKA

telephone- 6148225961

adminstrator/authorized_agent- MOHAMED HERSI

license_type-  LIMITED LIABILITY COMPANY

swing_status-

hfid- 42753

license_number- 423823

medicare_number-

mn_classification- PROVISIONAL ASSISTED LIVING FACILITY

federal_classification-

hcbs_designation-

hosp-N

alf-4

https://www.health.state.mn.us/facilities/regulation/assistedliving/index.html

https://www.revisor.mn.gov/statutes/cite/144G.91