1043986409 NPI number — MYSKYE CARE

Table of content: (NPI 1043986409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043986409 NPI number — MYSKYE CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MYSKYE CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043986409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4324 MARIGOLD AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55443-1546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-226-5766
Provider Business Mailing Address Fax Number:
612-500-4330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7671 CENTRAL AVE NE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRIDLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55432-3542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-398-1996
Provider Business Practice Location Address Fax Number:
612-500-4330
Provider Enumeration Date:
08/17/2021

Additional Information

Authorized Official

Authorized Official Last Name:
KUNERT
Authorized Official First Name:
CIARA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
651-398-1996

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A196600700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: A550031400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com