Healthcare Provider Details

I. General information

NPI: 1295286748
Provider Name (Legal Business Name): CERTIFIED CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 NOBLE CT N
BROOKLYN PARK MN
55443-3465
US

IV. Provider business mailing address

4080 W BROADWAY AVE #140A
ROBBINSDALE MN
55422-5604
US

V. Phone/Fax

Practice location:
  • Phone: 763-291-1162
  • Fax:
Mailing address:
  • Phone: 763-291-1162
  • Fax: 612-437-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1081849-1-HCBS
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1081849-1-HCBS
License Number StateMN

VIII. Authorized Official

Name: MRS. IYABO OLUWAKEMI ADEYEMI
Title or Position: OWNER
Credential:
Phone: 763-291-1162