Provider Demographics
NPI:1760362511
Name:AUTHENTIC LIVING SERVICES LLC
Entity type:Organization
Organization Name:AUTHENTIC LIVING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:HANAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-299-2996
Mailing Address - Street 1:1808 UNIVERSITY AVE NE APT 111
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-4315
Mailing Address - Country:US
Mailing Address - Phone:651-299-2996
Mailing Address - Fax:
Practice Address - Street 1:1808 UNIVERSITY AVE NE APT 111
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-4315
Practice Address - Country:US
Practice Address - Phone:651-299-2996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health