Healthcare Provider Details

I. General information

NPI: 1376774687
Provider Name (Legal Business Name): ULTIMATE CARE GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7040 LAKELAND AVE N SUITE 208
BROOKLYN PARK MN
55428-5600
US

IV. Provider business mailing address

7040 LAKELAND AVE N SUITE 208
BROOKLYN PARK MN
55428-5600
US

V. Phone/Fax

Practice location:
  • Phone: 763-560-9890
  • Fax: 763-560-9891
Mailing address:
  • Phone: 763-560-9890
  • Fax: 763-560-9891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberCLASS A 343995
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberCLASS F348031
License Number StateMN

VIII. Authorized Official

Name: MR. ALFRED APATA
Title or Position: DIRECTOR
Credential:
Phone: 763-560-9890