Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Provenance Homes 1, LLC

Organization Assisted Living Facility · NPI 1356191928

Provenance Homes 1, LLC is an Assisted Living Facility in Minneapolis, Minnesota. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3641 28th Ave S Unit 1
Minneapolis, MN 55406-2515
Phone: (612) 940-2104
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Assisted Living Facility (primary) Taxonomy 310400000X

Record details

NPI number1356191928
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mark Globus — Chief Manager · (612) 940-2104
NPI enumeratedMarch 25, 2024
Last updated in NPPESMarch 25, 2024
Certification dateMarch 25, 2024
Mailing address1650 W End Blvd Ste 100, St Louis Park, MN 55416-5369

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