PROVIDENCE HEALTH CARE SERVICES
NPI 1457047037
Assisted Living Facility in Blaine, MN

Q: What is Providence Health Care Services's NPI number?

The NPI number for Providence Health Care Services is 1457047037. It was assigned to this organization in the NPPES registry on April 17, 2023. The provider is also known as Sunrise Assisted Living.

Q: What is Providence Health Care Services's specialty?

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

Active since April 17, 2023CLIA 24D2304328 · Waiver

781 103RD AVE NE, BLAINE, MN 55434(612) 456-2773(763) 374-4469 Get Directions Write a Review

NPPES record last updated: May 30, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

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About Providence Health Care Services NPPES

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

PROVIDENCE HEALTH CARE SERVICES (NPI 1457047037) is a healthcare organization registered as an assisted living facility in Blaine, Minnesota and active in the NPI registry since April 2023. The organization holds a CLIA Waiver certificate valid through May 9, 2028, maintains a secondary practice location in Ramsey, and lists Jared Kenyanya, Ceo, as its authorized official.

NPPES Registry Identity

NPI1457047037

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NamePROVIDENCE HEALTH CARE SERVICES

Location Address781 103RD AVE NEBlaine, MN 55434-4507

Mailing Address781 103rd Ave NeBlaine, MN 55434-4507 · (612) 456-2773 · Fax (763) 374-4469

Phone(612) 456-2773

Fax(763) 374-4469

Organization SubpartNo

Authorized OfficialJared KenyanyaCeo · (612) 456-2773

Enumeration DateApril 17, 2023

Last NPPES UpdateMay 30, 2025

NPPES CertifiedMay 30, 2025

✔ NPI 1457047037 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.

781 103RD AVE NE, Blaine, MN 55434

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Other Names 1

Other NameSunrise Assisted Living

Secondary Practice Location 1

Location 115236 Germanium Cir NWRamsey, MN 55303-5163 · Phone (763) 444-1811 · Fax (763) 444-1868

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 24D2304328

Providence Health Care Services · Blaine, MN

Active · expires May 9, 2028

CLIA Number24D2304328

Laboratory TypeAssisted Living Facility

Certificate Effective DateMay 10, 2026

Certificate Expiration DateMay 9, 2028

Laboratory DirectorJared O. Kenyanya

Laboratory Phone(612) 456-2773

Laboratory LocationProvidence Health Care Services781 103rd Ave NE, Blaine, MN 55434

CLIA data matches this NPI record on: Address 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 Providence Health Care Services's NPI number?

The NPI number for Providence Health Care Services is 1457047037. It was assigned to this organization in the NPPES registry on April 17, 2023. The provider is also known as Sunrise Assisted Living.

Where is Providence Health Care Services located?

Providence Health Care Services is located at 781 103rd Ave NE, Blaine, MN 55434. The listed phone number is (612) 456-2773.

What is Providence Health Care Services's specialty?

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

Does Providence Health Care Services hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2304328) is associated with this NPI, valid through May 9, 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 Providence Health Care Services was last updated on May 30, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.