Provider Demographics
NPI:1083209472
Name:CARESTAY HOMES LLC
Entity type:Organization
Organization Name:CARESTAY HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDULRAZAQ
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:JIBAR
Authorized Official - Suffix:
Authorized Official - Credentials:HOME CARE DIRECTOR
Authorized Official - Phone:612-230-1238
Mailing Address - Street 1:7381 MEMORY LN NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3218
Mailing Address - Country:US
Mailing Address - Phone:612-230-1238
Mailing Address - Fax:612-435-0298
Practice Address - Street 1:7381 MEMORY LN NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3218
Practice Address - Country:US
Practice Address - Phone:612-230-1238
Practice Address - Fax:612-435-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility