Organization · NPI-2

Plateau Healthcare Maple Grove LLC

Nursing Care · Maple Grove, MN

NPI number1811544166

StatusActive

Last updated in NPPESAug 21, 2019

Details

NPI: 1811544166
Entity type: Organization (NPI-2)
Legal business name: Plateau Healthcare Maple Grove LLC
Organization subpart: No
Enumeration date: Aug 21, 2019
Last updated: Aug 21, 2019

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
251J00000X	Nursing Care	–	–	Yes
251E00000X	Home Health	–	–
253Z00000X	In Home Supportive Care	–	–

Other names

Phc Maple Grove (Doing Business As)

Practice location

9962 104th Ave N
Maple Grove, MN 55369-2941

Phone 763-444-1361 · Fax 763-444-1358

Mailing address

8848 Zealand Ave N Ste B
Brooklyn Park, MN 55445-1891

Phone 763-444-1361 · Fax 763-444-1358

Authorized official

Faisale Boukari
President
7634441361

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