Provider Demographics
| NPI: | 1225676067 |
|---|---|
| Name: | LIANA HEALTHCARE P.LL.C |
| Entity type: | Organization |
| Organization Name: | LIANA HEALTHCARE P.LL.C |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | MEDICAL DIRECTOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | LILIANA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | KIGONYA |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 651-300-4355 |
| Mailing Address - Street 1: | 8348 BEARD RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BLOOMINGTON |
| Mailing Address - State: | MN |
| Mailing Address - Zip Code: | 55431-1028 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 8348 BEARD RD |
| Practice Address - Street 2: | |
| Practice Address - City: | BLOOMINGTON |
| Practice Address - State: | MN |
| Practice Address - Zip Code: | 55431-1028 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 651-300-4355 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2019-12-11 |
| Last Update Date: | 2019-12-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | |
| No | 261QM1000X | Ambulatory Health Care Facilities | Clinic/Center | Migrant Health |
| No | 261QM1102X | Ambulatory Health Care Facilities | Clinic/Center | Military Outpatient Operational (Transportable) Component |
| No | 251B00000X | Agencies | Case Management | |
| No | 251G00000X | Agencies | Hospice Care, Community Based | |
| No | 261QM2800X | Ambulatory Health Care Facilities | Clinic/Center | Methadone |
| No | 253Z00000X | Agencies | In Home Supportive Care | |
| No | 261QP2400X | Ambulatory Health Care Facilities | Clinic/Center | Prison Health |
| No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
| No | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | |
| No | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility | |
| No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
