=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992238190
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CERTIFIED CARE PLANNER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2017
-----------------------------------------------------
Last Update Date | 04/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 E 66TH STREET SUITE 105
-----------------------------------------------------
City | RICHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-478-2778
-----------------------------------------------------
Fax | 651-309-1964
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1515 E 66TH STREET SUITE 105
-----------------------------------------------------
City | RICHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-478-2778
-----------------------------------------------------
Fax | 651-309-1964
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. RIWA OBEL NSANGALUFU
-----------------------------------------------------
Credential | CNA
-----------------------------------------------------
Telephone | 612-478-2778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------