MEDICARE: ULTIMATE CARE GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	CLASS F348031	MN
2	251E00000X	Home Health Agency	CLASS A 343995	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376774687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTIMATE CARE GROUP, INC

Provider Business Mailing Address
First Line	:	7040 LAKELAND AVE N
Second Line	:	SUITE 208
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428-5600
Country	:	US
Telephone Number	:	763-560-9890
Fax Number	:	763-560-9891

Provider Business Practice Location Address
First Line	:	7040 LAKELAND AVE N
Second Line	:	SUITE 208
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428-5600
Country	:	US
Telephone Number	:	763-560-9890
Fax Number	:	763-560-9891

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. ALFRED APATA
Credential	:
Telephone Number	:	763-560-9890

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	10/21/2010

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Directions to “ULTIMATE CARE GROUP, INC ” Practice Location

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