Healthcare Provider Details

I. General information

NPI: 1184824534
Provider Name (Legal Business Name): THREE K'S CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 36TH AVE N
CRYSTAL MN
55427-2014
US

IV. Provider business mailing address

7600 BASS LAKE RD SUITE 101
NEW HOPE MN
55428-3860
US

V. Phone/Fax

Practice location:
  • Phone: 763-546-1117
  • Fax: 763-546-1118
Mailing address:
  • Phone: 763-544-3148
  • Fax: 763-544-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number340738
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number340724
License Number StateMN

VIII. Authorized Official

Name: QUEENA KOTU SLOAN
Title or Position: LPN/ CEO
Credential: L.P.N.
Phone: 763-913-0325