PROVENANCE HOMES 1, LLC
NPI 1356191928
Assisted Living Facility in Minneapolis, MN

Q: What is Provenance Homes 1, LLC's NPI number?

The NPI number for Provenance Homes 1, LLC is 1356191928. It was assigned to this organization in the NPPES registry on March 25, 2024.

Q: What is Provenance Homes 1, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Active since March 25, 2024

3641 28TH AVE S UNIT 1, MINNEAPOLIS, MN 55406(612) 940-2104 Get Directions Write a Review

NPPES record last updated: March 25, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Provenance Homes 1, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVENANCE HOMES 1, LLC (NPI 1356191928) is a healthcare organization registered as an assisted living facility in Minneapolis, Minnesota and active in the NPI registry since March 2024. The organization lists Mark Caleb Globus, Chief Manager, as its authorized official.

NPPES Registry Identity

NPI1356191928

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NamePROVENANCE HOMES 1, LLC

Location Address3641 28TH AVE S UNIT 1Minneapolis, MN 55406-2515

Mailing Address1650 W End Blvd Ste 100St Louis Park, MN 55416-5369 · (612) 940-2104

Phone(612) 940-2104

Organization SubpartNo

Authorized OfficialMark Caleb GlobusChief Manager · (612) 940-2104

Enumeration DateMarch 25, 2024

NPPES CertifiedMarch 25, 2024

✔ NPI 1356191928 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities

Taxonomy Code310400000X

Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

3641 28TH AVE S UNIT 1, Minneapolis, MN 55406

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Provenance Homes 1, LLC's NPI number?

The NPI number for Provenance Homes 1, LLC is 1356191928. It was assigned to this organization in the NPPES registry on March 25, 2024.

Where is Provenance Homes 1, LLC located?

Provenance Homes 1, LLC is located at 3641 28th Ave S Unit 1, Minneapolis, MN 55406. The listed phone number is (612) 940-2104.

What is Provenance Homes 1, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

When was this NPI record last updated?

The NPPES record for Provenance Homes 1, LLC was last updated on March 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.