Healthcare Provider Details

I. General information

NPI: 1992450324
Provider Name (Legal Business Name): CHEZ MICHAEL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5748 REGENT AVE N
CRYSTAL MN
55429-2815
US

IV. Provider business mailing address

3300 COUNTY ROAD 10 STE 300B
BROOKLYN CENTER MN
55429-3066
US

V. Phone/Fax

Practice location:
  • Phone: 269-873-0690
  • Fax:
Mailing address:
  • Phone: 269-873-0690
  • Fax: 800-966-2364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: OLUBUNMI SIMPEH
Title or Position: OWNER
Credential:
Phone: 612-888-3515