Provider Demographics
NPI:1215425616
Name:RAPHA HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:RAPHA HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ATINUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LADIPO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-701-3760
Mailing Address - Street 1:3300 COUNTY ROAD 10 STE 525
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3072
Mailing Address - Country:US
Mailing Address - Phone:612-701-3760
Mailing Address - Fax:
Practice Address - Street 1:7816 HUMBOLDT AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55444-2140
Practice Address - Country:US
Practice Address - Phone:763-208-6772
Practice Address - Fax:763-208-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN385786251E00000X
251J00000X, 253Z00000X, 3104A0625X, 3104A0630X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN385786OtherCOMPREHENSIVE HOME CARE