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General NPI Number Information
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NPI Number | 1578318994
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Entity Type | Organization
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Legal Business Name | BOKA HAVEN INC
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Dates
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Enumeration Date | 04/19/2024
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 5251 386TH STREET
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City | NORTH BRANCH
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State | MN
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Zip | 55056
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Country | US
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Telephone | 651-350-2840
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Fax |
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Provider Business Mailing Address
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Address Line | 912 104TH LN NE
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City | BLAINE
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State | MN
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Zip | 55434-1561
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Country | US
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Telephone | 651-350-2840
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Fax |
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Authorized Official
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Title or Position | CEO/LALD
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Name | ETTAFA BOKA
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Credential | LALD
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Telephone | 651-350-2840
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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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