Healthcare Provider Details

I. General information

NPI: 1982816807
Provider Name (Legal Business Name): XTRA CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 ROOSEVELT ST
ANOKA MN
55303
US

IV. Provider business mailing address

1334 ROOSEVELT ST
ANOKA MN
55303
US

V. Phone/Fax

Practice location:
  • Phone: 612-558-1583
  • Fax: 763-208-0568
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMN

VIII. Authorized Official

Name: PATSY NDIDI JIBUNOR
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 612-558-1583