PRIME HEALTHCARE SERVICES LLC, CHAMPLIN

provider_name-PRIME HEALTHCARE SERVICES LLC

physical_address- 11333 WELCOME AVENUE

physical_city-CHAMPLIN

physical_state -MN

physical_zip- 55316

county_name-HENNEPIN

telephone- 6513548544

adminstrator/authorized_agent- WOSILAT SOBOYEDE

license_type-  LIMITED LIABILITY COMPANY

swing_status-

hfid- 40699

license_number- 417127

medicare_number-

mn_classification- PROVISIONAL ASSISTED LIVING FACILITY

federal_classification-

hcbs_designation-

hosp-N

alf-5

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

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