Healthcare Provider Details

I. General information

NPI: 1336702000
Provider Name (Legal Business Name): ELITE QUALITY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 MAIN ST NE
MINNEAPOLIS MN
55418-1144
US

IV. Provider business mailing address

3555 MAIN ST NE
MINNEAPOLIS MN
55418-1144
US

V. Phone/Fax

Practice location:
  • Phone: 952-465-1522
  • Fax:
Mailing address:
  • Phone: 952-465-1522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. MUNA MOHAMED JAMA
Title or Position: REGISTERED NURSE
Credential: RN, BSN
Phone: 952-465-1522