Provider Demographics
NPI:1154046126
Name:CERTIFIED CARE PLANNER LLC
Entity type:Organization
Organization Name:CERTIFIED CARE PLANNER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:KETA
Authorized Official - Middle Name:
Authorized Official - Last Name:MWAKILUMA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-478-2778
Mailing Address - Street 1:1811 BIRMINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-4510
Mailing Address - Country:US
Mailing Address - Phone:612-478-2778
Mailing Address - Fax:651-309-1964
Practice Address - Street 1:1811 BIRMINGHAM ST
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-4510
Practice Address - Country:US
Practice Address - Phone:612-478-2778
Practice Address - Fax:605-309-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility