CUSTOMIZE LIVING LLC, BLAINE

provider_name-CUSTOMIZE LIVING LLC

physical_address- 2842 85TH COURT NE

physical_city-BLAINE

physical_state -MN

physical_zip- 55449

county_name-ANOKA

telephone- 6129995829

adminstrator/authorized_agent- SULEBAN HUSSEIN

license_type-  For-Profit Limited Liability Company

swing_status-

hfid- 35628

license_number- 422229

medicare_number-

mn_classification- 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