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General NPI Number Information
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NPI Number | 1265146757
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Entity Type | Organization
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Legal Business Name | FORTUNATE QUALITY CARE
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 6930 HALIFAX AVE N
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-1372
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Country | US
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Telephone | 612-816-8290
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Fax |
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Provider Business Mailing Address
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Address Line | 6930 HALIFAX AVE N
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-1372
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Country | US
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Telephone | 612-487-2027
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FARTON ABDISALAN
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Credential |
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Telephone | 612-487-2027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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