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PRIME LIVING MN LLC
NPI 1376496612
Assisted Living Facility - Assisted Living, Behavioral Disturbances in Eagan, MN

Active since February 17, 2026CLIA 24D2343310 · Waiver
2110 WUTHERING HEIGHTS RD, EAGAN, MN 55122(443) 310-0126 Get Directions Write a Review

NPPES record last updated: February 17, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Prime Living Mn Llc NPPES

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

PRIME LIVING MN LLC (NPI 1376496612) is a healthcare organization registered as an assisted living, behavioral disturbances in Eagan, Minnesota and active in the NPI registry since February 2026. The organization holds a CLIA Waiver certificate valid through May 4, 2028 and lists Mohamed I Mouhoumed, Owner, as its authorized official.

NPPES Registry Identity

NPI1376496612
Entity TypeOrganization
Primary Taxonomy3104A0630X
Legal Business NamePRIME LIVING MN LLC
Location Address2110 WUTHERING HEIGHTS RDEagan, MN 55122-1028
Mailing Address2110 Wuthering Heights RdEagan, MN 55122-1028 · (443) 310-0126
Phone(443) 310-0126
Organization SubpartNo
Authorized OfficialMohamed I MouhoumedOwner · (443) 310-0126
Enumeration DateFebruary 17, 2026
NPPES CertifiedFebruary 17, 2026
✔ NPI 1376496612 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living Facility · Assisted Living, Behavioral DisturbancesNursing & Custodial Care Facilities
Taxonomy Code3104A0630X
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being. This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors.
2110 WUTHERING HEIGHTS RD, Eagan, MN 55122
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D2343310

Prime Living Mn LLC · Eagan, MN
Active · expires May 4, 2028
CLIA Number24D2343310
Laboratory TypeAssisted Living Facility
Certificate Effective DateMay 5, 2026
Certificate Expiration DateMay 4, 2028
Laboratory DirectorMouhoumed Mohamed
Laboratory Phone(443) 310-0126
Laboratory LocationPrime Living Mn LLC2210 4th Ave N, Eagan, MN 55122
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Prime Living Mn LLC's NPI number?

The NPI number for Prime Living Mn LLC is 1376496612. It was assigned to this organization in the NPPES registry on February 17, 2026.

Where is Prime Living Mn LLC located?

Prime Living Mn LLC is located at 2110 Wuthering Heights Rd, Eagan, MN 55122. The listed phone number is (443) 310-0126.

What is Prime Living Mn LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility, specializing in Assisted Living, Behavioral Disturbances, with taxonomy code 3104A0630X.

Does Prime Living Mn LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2343310) is associated with this NPI, valid through May 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Prime Living Mn LLC was last updated on February 17, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months 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.