Provider Demographics
NPI:1396993036
Name:CHRISTINE PROFESSIONAL HEALTH CARE INC
Entity type:Organization
Organization Name:CHRISTINE PROFESSIONAL HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:OSARO
Authorized Official - Last Name:OHENZUWA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:763-464-4072
Mailing Address - Street 1:9970 MADISON ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4207
Mailing Address - Country:US
Mailing Address - Phone:763-464-4072
Mailing Address - Fax:763-784-9322
Practice Address - Street 1:9970 MADISON ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4207
Practice Address - Country:US
Practice Address - Phone:763-464-4072
Practice Address - Fax:763-784-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-07
Last Update Date:2008-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNHE0108404310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA185457000OtherUMPI MINNESOTA HEALTH CARE PROGRAM MHCP
MNA265455100OtherUMPI MINNESOTA HEALTH CARE PROGRAM MHCP
MNA936637200OtherUMPI MINNESOTA HEALTH CARE PROGRAM MHCP
MNA562678200OtherUMPI MINNESOTA HEALTH CARE PROGRAMS